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L. A. DUGAS, M. D., 


Medical College of Georgia. 

Jc prends Ic bien ou jc k trouve." 

VOL. IX.— 1853.— NEW SERIES. 





Vol. 9.] NEW SERIES.— JANUARY, 1851.- [No. 1. 


(Original Communications. 


On Anaesthetic Agents. By Charles T. Jacksox, M. D., 
Chevalier de la Legion d'Honneur, late Geologist and Chem- 
ist to the States of Maine, New Hampshire, Rhode Island, 
and the United States; Assayer to the State of Massachu- 
setts, &c, &c. 

BOSTON, October 23d, 1852. 
Prof. L. A. Dugas : 

My Dear Sir — I comply most cheerfully with your request, 
that I should prepare a short account of the use of Anaesthetic 
Agents in Surgery and Midwifery for publication in your 
valuable medical journal. I have for some time had it in con- 
templation to prepare for the press a volume, containing all the 
information that I possess on the subject, with a digest of the 
numerous works that have been published upon it by distin- 
guished scientific and medical gentlemen of Europe, but my 
professional and official duties have occupied my time so com- 
pletely as to have prevented my accomplishing this task; and 
I should desire to visit Europe, in order to collect all the best 
observations, before publishing a work of so important a char- 
acter. I have decided, however, to begin here, and to work up 
such materials as are in my hands ; after which, I hope to have 
the pleasure of consulting with my generous friends in Europe, 
and to collect all the scattered information of a practical char- 

v. s. — VOL. ix. no. i. 1 

6 Jackson, on Ancesthetic Agents. [January, 

acter that may b.e needed to complete a work worthy of the 
subject, and sufficient to meet the wants of the medical world. 
This, the public may expect from my hands. 

I have now before me a number of books and pamphlets, on 
the use of anaesthetic agents, which have emanated from the 
presses of Europe — twenty-one of them are in the German 
language, one in Latin, three in French, and one in Italian, 
while only two or three pamphlets have been published in 
England, on Chloroform, and only one regular work on the use 
of Ether and Chloroform in Child-birth, and a pamphlet on 
Ether, have, thus far, appeared in America. Unfortunately, 
the public mind has been more occupied with the disputes 
which have taken place here as to the origin of the discovery, 
than with the rational investigation of the principles and prac- 
tice of Etherization. This, I trust, will cease to agitate us 
much longer ; for the question of discovery has been passed 
upon by the highest of scientific tribunals — the Institute of 
France — and it is no longer open for discussion, excepting so 
far as concerns the appropriation of some reward for the dis- 
covery by the Congress of the United States, and even that 
I have not sought, prefering that the act should emanate spon- 
taneously from the councils of the nation. France and Sweden 
have already shewn, by liberal acts, their approbation of this 
discovery, and it is to be hoped that our'own country will not 
long delay that justice which is expected from her hands. 

Leaving this question, permit me now to enter upon the sub- 
ject of the practical administration of anaesthetic agents; and 
let us enquire, first, what are the means that have been pro- 
posed and employed for the production of anaesthesia? 

Mesmeric influence, whatever may be its nature, has cer- 
tainly acted as a sedative to nervous sensibility, and to such an 
extent as to prevent the perception of pain during severe surgi- 
cal operations. Of this fact, we have ample evidence on record 
in this country, in Europe, and in Asia ; and though I have 
not myself seen any successful case in the practice of Boston 
surgeons, and am not aware of any having occurred in our 
hospital, I am satisfied, from the evidence of those whose state- 
ments may be fully relied upon, that anaesthesia has been really 

1853.] Jackson, on Ancesthetic Agents. 

superinduced in surgical patients by operations of a mes- 
meric character. I may be allowed to allude to the striking 
and well attested cases, published in this journal, by Dr. L. A. 
Dugasjin 1845, pp. 122 and 508, and in 1846, p. 72. 

The objection which surgeons make to any reliance on this 
mysterious nervous agency is, that there are very few persons 
who are capable of being put into a mesmeric state, even when 
not alarmed by the terror of a severe surgical operation, and 
that even facile subjects may be so agitated as to prevent any 
effectual influence being exerted upon them — therefore, this 
power, whatever it may be, is not generally available. 

If we look back, to learn what other means have been proposed 
to render persons insensible to pain, we find that Humphry 
Davy, in the year 1800, published a work entitled, " Researches, 
Chemical and Philosophical, chiefly concerning Nitrous Oxide, 
or Dephlogistigated Nitrous Air and its Respiration. By Hum- 
phry Davy, superintendant of the Medical Pneumatic Institu- 
tion. London/' In this work, Davy gives an account of his 
experiments on the effects of inhalation of protoxide of nitrogen, 
and in one of his experiments, he says, while suffering from the 
pain attendant upon the cutting of a wisdom tooth, " on the day 
when the inflammation was most troublesome, I breathed three 
large doses of nitrous oxide. The pain always diminished after 
the first four or five inspirations ; the thrilling came on, as usual, 
and uneasiness w r as for a few moments swallowed up in pleas- 
ure. As the former state of the mind returned, the state of the 
organ returned with it ; and I once imagined that the pain was 
more severe after the experiment than before." (Page 465.) 

Again, on page 464, he says, after breathing the nitrous oxide, 
" I imagined that 1 had increased sensibility of touch : my fin- 
gers were pained by anything rough, and the tooth ci]^e pro- 
duced from slighter causes than usual. I was certainly mure 
irritable, and felt more acutely from trifling circumstances." 

This increased irritability produced by inhalation of protox- 
ide of nitrogen, is confirmed by the statement of Dr. Beddoes, 
the employer of Davy, on page 543, of the same work, who 
says, "SevjeraJ times I have found that a cut which had ceased 
to be painful has smarted afresh, and on taking two doses in 
succession, the smarting ceased in the interval, and returned 
during the second respiration." 

Jackson, on Ancesthetic Agents. [January, 

Thus, it appears from the researches of the discoverer of 
exhilerating gas himself, and from the experience of his medi- 
cal instructer and employer, Dr. Beddoes, that protoxide of 
nitrogen has no anaesthetic properties, and the above quoted 
experiments were obviously made with an express view to the 
discovery of some pain-subduing properties in this gas. Davy 
has the credit of having made early attempts to the discovery 
of anaesthesia — but he did not find it. Horace Wells, a dentist, 
verified Davy's failure before the public in Boston, in 1844, and 
in 1847, he again failed in the same way in the hospitals of 
New York, thus giving as good evidence as was needed that 
protoxide of nitrogen is not an anaesthetic agent, in spite of 
all the depositions which he has published to prove that it was 
equal or superior to ether. 

We shall not consume the time of our readers by recounting 
the various absurd proposals which were made by a Dr. Hick- 
man, of England — such as the administration of carbonic acid 
gas by inhalation, so as to produce asphyxia, and of compress- 
ing the trachea so as to strangle the patient, and then to operate 
upon him while in that half dead state ; or the method proposed 
by Morgagni, of compressing the jugular veins until a sort of 
apoplexy was brought on; for these methods were at once 
rejected by the French Academy of Medicine, as too absurd 
for trial and wholly unjustifiable. And we cannot but marvel, 
that any one should claim for Doctor Hickman the discovery 
of anaesthesia on account of these barbarous proposals, which, 
thanks to the humanity of the Academy, were never inflicted 
upon any surgical patient. Nor will it be necessary for me to 
look over ancient Persian, Hindoo, Chinese, Greek, or Roman 
books, to learn that means were sought for and proposed, for 
preventing pain in surgical operations.* It is enough for us to 
know that they never discovered any such means, and it is no 
novelty to us that mankind have always wished for such a dis- 
covery. It is well known, that the use of ether vapor for the 
production of insensibility to pain in surgical operations was 
made by me, and that the Institute of France so decided, after 

* Those who feel curious to learn the opinions of the ancients on this subject, 
are referred to the work of M. Louis Figuier. Exposition et Histoire Univer- 
seles des decouvertes Scientifiques et Modernes. Paris, 1852. 


Jackson, on Anesthetic Agents. 

a full examination of the claims of numerous contestants for the 
honor of this discovery. 

The method of operating with Ether Vapour and with Chlo- 
roform I shall now proceed to detail, premising the necessary- 
precautions in judging of the purity of thf> ether to be employed, 
and shewing how it may be purified from alcohol and acids 
which are frequently contained in the ether of commerce. 
Pure sulphuric ether is represented by the formula C 4 H 5 O. 
Its specific gravity from 0-724 at 54° F., or 0715 at 68° F. 
It is a light, highly volatile fluid, transparent, highly limpid and 
colourless. Its odour is fragrant and peculiar. It boils at from 
96° to 98° F., and evaporates with great rapidity when exposed 
to the air, leaving nothing behind if it is pure. Owing to its 
rapid volatilization it abstracts heat from bodies with great 
rapidity. It burns with a white flame, and produces carbonic 
acid gas and water. 

Ether unites with alcohol readily, and is completely dissolved 
by it, but may be separated from it by agitation with water, 
for water combines rapidly with the alcohol and abstracts it 
from the ether, which is but slightly soluble in water, and being 
lighter it floats upon its surface. Owing to this property, we 
can readily wash out those impurities in ether which are solu- 
ble in water, and for that purpose I employ a very simple 
apparatus, called a washing bottle, which is represented in the 
wood cut below. 

a glass jar. 
a b air tube, 
j c tube for drawing off the ether. 

d division line between the ether 
and the water. 

A stop cork may be affixed to the 
tube c, which may be made of metal, 
if desirable. These tubes are insert- 
ed through a cork. 

Take the ether, and evaporate a portion of it to dryness on 
a cloth, and if there is much odour remaining on the cloth the 

10 Jackson, on Anaesthetic Agents. [January, 

ether is impure. Smell of it as it evaporates to ascertain if 
any sulphurous acid is present. Test it also with a slip of blue 
litmus paper to discover if it is acid ; for if it is, it will turn the 
blue paper red. 

To test it for alcohol. After washing the ether, distill the 
alcohol from the water, by means of a retort and Leibig's con- 
denser, and the alcohol will be obtained, and may be rectified, 
as usual, by re-distillation from dry carbonate of potash, or 
from dry chloride of calcium. 

For practical purposes, if the ether has no smell of sulphur- 
ous acid, we need only to wash it with about twice its bulk of 
water. For this, we use the washing bottle above figured. 
Set the bottle upright, and fill it one-third full of ether, and then 
nearly fill it with water, and shake it up for a few minutes, and 
then invert the bottle, stopping the tube c before inverting it. 
Hold it in this position for a short time, until the line of separa- 
tion between the ether and the water is well defined; then open 
the tube c, and let the water gently flow out, as it will do, on 
account of the ready passage of air up the tube b, to the top of 
the liquor. As soon as the ether reaches the tube c, stop it, 
and bringing it over the bottle in which you intend to preserve 
the ether, open the tube c again, and allow the ether to flow 
into it. 

This ether, without any re-distillation, is suitable for inhala- 
tion ; but if it is to be rendered perfectly dry, add a quantity of 
dried chloride of calcium, and after agitation for some time, 
distill off the ether, condensing the fluid by means of Leibig's 
condenser and ice water. 

I sometimes have rendered ether less offensive to the smell 
by agitating it with lime-water, or still better, with bleaching 
powder, hyperchlorite of lime, which destroys the aroma of 
some of the volatile oils which it may accidentally contain. 
This ether is to be again washed with water, and it is then fit 
for use. 

Many of the accidents which have happened in the early use 
of ether as an anaesthetic agent, (though none of them have 
proved fatal,) arose from the use of impure alcoholic ether of 
commerce, and ether containing sulphurous acid ; this acid 
being not. unfrequently present in the ether of commerce, 

1853.] Jackson, on Ancesthetic Agents. 11 

which is not always prepared with sufficient care, organic 
matter, such as straw, cork, or other things that decompose 
sulphuric acid, and generate sulphurous acid being present. 

The utmost care is required in the manufacture of ether for 
inhalation, and none but colourless oil of vitriol and purified 
alcohol should be employed in its preparation. 

Mode of administration of Ether Vapour for the production 
of Anaesthesia. — No other apparatus is required than a large 
sponge, or a porous towel. A good sponge is the most con- 
venient, and should not be smaller than the two fists of a man — 
viz., from four to six inches in diamater. The form of the 
sponge is of no consequence, provided it is large enough. 

Let the patient recline in an easy chair, or if on the opera- 
ting couch, let his head and shoulders be elevated, if he reclines 
upon his back ; but if he lies upon his side, he may remain pro- 
cumbent. Soften the sponge in water, so as to open its texture, 
and squeeze it as dry as convenient — pour it full of the ether, 
and squeeze out enough to prevent its dropping — bring the 
sponge close to the open mouth of the patient, and let him 
breathe fully and boldly. The first impression of the ether 
upon the respiratory organs produces coughing at first, but 
is soon borne without trouble, and the patient inhales the ether 
with great eagerness. Let him inhale it as freely as possible, 
for the best effects are those which are soonest brought about, 
as no excitement arises if the vapour is given freely, while it 
is likely to take place if given too gradually. The patient in a 
few minutes is etherized — his eyes close, and he falls back, as 
if asleep. If you open his eyelids you will find the eye rolled 
up, as in sound sleep. The pupil is at first contracted, but soon 
dilates under a full dose. The pulse, at first quickened, is, un- 
der full etherization rendered slower than natural, and gener- 
ally may be diminished about ten beats a minute less than the 
natural pulse. Under chloroform, it is not unfrequently re- 
duced from 72 to 30 beats per minute, and it gradually rises as 
the patient recovers from the effects of the anaesthetic agent. 

There is no need of rendering all patients unconscious ; for 
loss of all feeling takes place before the unconscious state com- 
mences, and there is no difficulty in keeping the patient for 

12 Jackson, on Ancesthetic Agents. [January, 

hours just on the borders of unconsciousness, without passing 
into that state. The surgeon should charge an assistant with 
the duty of administering the ether, in order that he should be 
able to devote his undivided attention to the operation, and the 
etherizer should devote his attention to his particular duty. 

In case the patient has become deeply unconscious, and it is 
desirable to awaken him, we have only to sponge his face 
and head quickly with ice water, when he will generally be 
aroused — at least this method hastens the recovery in a re- 
markable manner. 

It is very important for the surgeon to know that the patient 
should not be etherized while his stomach is full of food, for he 
will be made to vomit in most cases, and he is much more re- 
fractory towards the etherization. Make it a rule, then, that 
the patient is to be kept fasting for some hours before he is to 
be operated upon by ether ; also, that he drinks no ardent spir- 
its, wine, or beer, which oppose the anaesthetic effects of ether. 
Men who are habitually temperate always are the best subjects 
for etherization, and habitual intemperance often prevents per- 
sons from being affected favorably by anaesthetic agents. It is 
a great mistake to suppose, that etherization is equivalent to 
drunkenness from alcohol, or from exhilerating gas : it is di- 
rectly opposed to that state. Alcohol excites to violence, and 
so does the protoxide of nitrogen — while ether vapour, pro- 
perly administered, acts very quickly as a sedative, and there is 
no disposition shewn to violent actions. 

It is wholly unnecessary to detail cases, for the world has 
been flooded with them, and three or four well-observed ones 
are as good as a thousand. I have made direct experiments 
upon habitual inebriates, and upon men who never drank any 
intoxicating liquors in their lives, and I know, from these trials, 
that ardent spirits act directly against the true and proper 
influence of ether. 

In Parturition, there is rarely any need of rendering the 
female unconscious. She can, by a little instruction, be taught 
how to prevent the sensation of pain in each muscular contrac- 
tion of the uterus, by anticipating it with the ether, a bottle of 
which she may have in one hand, while she holds her sponge, 
handkerchief, or towel in the other, and applies the ether over 

1853.] Jackson, on Ancesthelic Agents. 13 

her mouth as she needs it. Since the introduction of pure 
chloroform, I have been in the habit of making a mixture of it 
with ether, and thus avoid the peculiar dangers of chloroform. 
One measure of pure chloroform, made as I shall presently 
describe, and four measures of pure washed sulphuric ether, 
mixed, forms the most convenient anaesthetic agent for the 
practitioner, since a four ounce phial will contain enough for 
any case of labour, and twice as much as is required for any 
surgical operation. This mixture, which should be freshly 
made for each case, I ha-ve found to be perfectly safe, and I 
have used it for more than five years, in my family, and on 
numerous patients who have required my surgical aid, without 
having witnessed a single unfavorable symptom. I have kept 
an American Indian four hours in an insensible and unconscious 
state with it, and have administered it to many furious maniacs, 
in McLean Asylum, with great advantage ; the patients gaining 
rest and sleep for some time, were found to be much relieved, 
and one furious maniac was cured, for the time at least. 

In Midwifery this mixture of ether with pure chloroform 
operates admirably, and the accoucheur may, after instructing 
his patient in the mode of inhaling it, allow her to take the 
phial into her own hands, and to shake a little of the mixture 
upon her handkerchief, just as cologne spirits is used, and then 
to inhale it from the handkerchief as she feels a pain coming 
on. If unconsciousness is desirable, as well as insensibility to 
pain, another person must be charged with the administration 
of the anaesthetic agent, under the directions of the accoucheur. 
This is always required when instruments are employed for 
the delivery of the child. I have used this mixture in my own 
family in cases of parturition, and, without producing uncon- 
sciousness, except for three minutes in one instance, have always 
prevented all sensation of pain, without a single unfavorable 
symptom accompanying or following its administration. I have 
also used it in every case when my children required their teeth 
to be extracted, and with the most agreeable effects. 

Pure chloroform is too powerful an agent to be used gener- 
ally, and since it is never required to be used alone and we 
have other and safer agents, its farther employment in its con- 
centrated state should be abandoned. Its vapour is so heavy 

14 Jackson, on Ancesthetic Agents. [January, 

as to nearly drown the patient, if he happens to draw into his 
lungs the pure vapour, and one inhalation too much may prove 
an over-dose and put the patient into a state of stupor beyond 
the wishes of the operator, and to the no small alarm of the 
friends of the patient. 

There are also poisonous kinds of chloroform in the market, 
which produce immediate death if breathed in a concentrated' 
form, and the physician and surgeon may be so unfortunate as 
to procure a bad variety. 

The fousel oil, or oil of whiskey, is not unfrequently present 
in the alcohol used for the manufacture of chloroform, and as 
I have ascertained by direct experiment, a poisonous chloride 
of amyle is present in most of the chloroform of commerce, 
Mr. At wood and myself having separated it from such chlo- 
roform. I have also made the poisonous product directly 
from a mixture of fousel oil, hyperchlorite of lime and water, 
and have proved that it destroys life. 

It is not. however, certainly ascertained, that this compound 
of amyle alone produces those sudden deaths, which under the 
hands of skilful practitioners have so quickly taken place, on 
the inhalation of impure chloroform, though the fluidity of the 
blood in these fatal cases seems to indicate that some such 
body as I have described must have been present, for I found 
that such results were produced by the amyle compound, when 
inhaled by animals; but, in my experiments, the death of the 
animals, a rat and a turtle (testudo picta), took place too slowly 
to resemble the known effects of the poisonous chloroform. I 
have not yet, however, tried this compound mixed of chloro- 
form, which may cause its more rapid action. 

I know that there is a kind of chloroform sold in this market 
that quickly decomposes and produces some remarkable and 
very disagreeable products and free chlorine; and I am in- 
formed by an eminent chemical manufacturer, Mr. Luther 
Atwood, that such chloroform, in his experiments, usually results 
from following the rules printed in the U. S. Dispensatory, 9th 
edition, page 841 — 1851 ; while, by following another method, 
similar to that which has been published by Prof. Simpson, 
good chloroform results, but it must be made from very pure 
alcohol, properly diluted with water. The chloroform which 

1853.] Jackson, on AncBsthetic Agents. 15 

I use, was manufactured by Mr. Atvvood, for Messrs. Philbrick, 
Carpenter & Co., of Boston, and it was made from alcohol 
purified by a process peculiar to his own works. This alcohol 
has no trace of fousel oil in it, and has not the odour of any 
of the materials from which it is extracted. The most highly 
rectified and pure alcohol alone is fit for the manufacture of 
chloroform. The process for making chloroform, as published 
by Simpson, is as follows : 

* ty Bleaching powder, Hyperchlorite of Lime, lbs. iv. 

Water, lbs. xii. 

Alcohol, oz. xii. 

Mix in a capacious retort or still, and distill so long as a dense 
liquid, which sinks in the water with which it comes over, is 

This chloroform must be washed in the washing bottle, be- 
fore described, with a sufficiency of water, to remove any 
alcohol or acids it may contain. The chloroform settles to 
the bottom and may be drawn ofTby the tube c, of that appar- 
atus. There is no need of a re-distillation of this chloroform 
from sulphuric acid or from chloride of calcicum — a thorough 
washing with water is all that is required. This chloroform is 
to be used with ether, as before described. 

There is a mixture of chloroform and alcohol sold under the 
improper name of Chloric Ether, which, when ^dmirtistered 
on a wet sponge, is decomposed, the alcohol all leaving the 
chloroform and uniting with the water, so that nothing but 
chloroform is really administered — not a particle of the alcohol 
rising in the vapor inhaled by the patient. The only advan- 
tage which can possibly arise from the use of this preparation, 
is the division of the chloroform into fine globules in the wet 
sponge ; but it is an uncertain mixture, and is as objectionable 
as pure chloroform — the use of it in a case at the Marine 
Hospital in Chelsea having produced death in a short space of 
time, in the same manner and with the same morbid appear- 
ances resulting, as are known to characterize the fatal admin- 
istration of bad chloroform. 

I have seen cases of violent and very dangerous convulsions 
continuing for three days, from the administration of chloroform, 
for the prevention of pain in the extraction of a tooth. These 

16 Jackson, on Ancesthetic Agents. [January, 

convulsions were found to be best controlled by the adminis- 
tration of proper doses of morphine, and the patient recovered 
in the course of a week. 

The first chloroform ever manufactured in the United States, 
for anaesthetic use, was made by me in my private laboratory, 
and was, after being tried upon myself, administered to my 
pupils. I then furnished physicians and surgeons with a suffi- 
cient quantity to prove its efficacy, and made an exhibition of 
it at a scientific club, where I administered it to our celebrated 
surgeon, Dr. John C. Warren, and to Mr. Joseph M. Wight- 
man. I subsequently administered it to physicians and to 
others in public lectures, and have employed it to some extent 
in various petty surgical cases which fell into my hands 
while I was engaged in public geological surveys. I have 
therefore had some experience in the use of this agent, as well 
as of ether, and although I have met with no accidents in 
practice with it, I must confess that I prefer my original anaes- 
thetic agent, pure ether, or its admixture with pure chloroform. 

Dr. Simpson, who substituted chloroform for ether, at the 
suggestion of Mr. Waldie, the chemist, still adheres to the 
administration of chloroform, but he is extremely careful to 
procure the purest kind, and will not employ that which is sold 
in the market unless he knows who made it, and that it is pure. 
I am ftot aware of any fatal case having happened under the 
management of Simpson, and this must be owing to his great 
care in selecting pure chloroform. If ether has not caused 
death in a single instance, and I am not aware of one having 
yet taken place in consequence of its use, why should we not 
adhere to its employment in all cases ? It is objected that its 
odour is not so agreeable as that of chloroform, and that it is 
more bulky and must therefore encumber the practitioner. 
These objections are in a great measure removed, by the sub- 
stitution of the mixture of ether and chloroform, as employed 
by me, and with due care little danger is to be apprehended 
from the use of this mixture. 

For philosophical experiments, we may wish to employ 
other substitutes for ether, and therefore I shall give a list of 
those which possess anaesthetic properties, with some remarks 
upon their peculiar effects upon man and animals. 

1853.] Jackson, on Anccsthetic Agents. 17 

They arc, as given in M. Bouisson's work on Anaesthesia — 

1st. Hydrochloric Ether, (first employed with Sulphuric 
Ether, by M. Flourens, of Paris, in 1847.) 

2d. Acetic Ether. (M. Figuier.) See Comptes Rendus of 
the French Academy of Science, 1848, and M. Bouisson's 
TraitS, 1850. Paris. 

3d. Nitrous Ether. (M. Flourens.) 

4th. Nitric Ether. (Dr. Simpson, on animals.) 

5th. Aldehyde. (M. Poggiale.) 

6th. Chloride of Hydrocarbon. (Dr. Nunnelly.) 

7th. Formomethykc. (M. Bouisson.) 

8th. Benzine. (Drs. Simpson and Snow.) 

9th. Bi-sulphide of Carbon. (Name of experimenter not 
known.) Norway Journal. 

Of these, I have tried Nos. 1, 5, 6, and 9, upon my own per- 
son, and No. 9, I have administered to my pupils, with rather 
alarming results, and have also tried it upon mjself. It is too 
powerful, and is dangerous. I have tried, too, chloride of 
methyle. and found it to act precisely like chloroform, or the 
ter-chloride of formyle. I have tried formic ether, and 
cenanthic ether, with unpleasant effects, and without anaesthe- 
sia being produced by them. Benzole has been breathed by 
me, but its effects were not satisfactory, and it produced con- 
siderable irritation in the fauces and larynx. I do not regard 
these agents as susceptible of being substituted advantageously 
for pure sulphuric ether. 

I will give here the results stated inM. Bouisson's admirable 
Traite de la Method Anesthesique, (Paris, 1850,) respecting 
those agents that have not been tried by me, remarking that 
M. Bouisson himself is decidedly in favor of adhering to the 
use of ether vapour, as originally proposed and employed by me. 

Chloride of ethyle, or hydrochloric ether, is made by satura- 
ting alcohol with chlohydric acid gas, and by distilling the 
liquid in a water bath, and condensing the ether in a flask of 
water surrounded with ice and salt. Hydrochloric ether boils 
at 11° centigrade or 42° P. M. Flourens first employed this 
ether in the place of sulphuric ether, and for comparison with 
it, and found that it produced the same effects. It is so volatile 
that it is difficult to keep, and can only be used in cold weather; 

18 Jackson, on Anesthetic Agents. [January, 

hence, is not employed to any extent in actual practice, for it 
would be necessary to keep it constantly surrounded by ice, 
to prevent its escape by evaporation, as it boils at 42° F. 

Acetic ether, or acetate of the oxide of ethyle, is a colour- 
less liquid, having an aromatic odour, somewhat between ether 
and acetic acid. Its density is 0*86, and boiling point 74° cent, 
or 95° F. This ether being less volatile than oxide of ethyle, 
is not so readily administered by inhalation, but, according to 
Figuier, it produces effects analogous to those of sulphuric 
ether. Tried on a puppy of 2| months, by M. Figuier, it pro- 
duced insensibility in five minutes, so that no pain was occasion- 
ed by amputation and cauterization of his tail, but it took ten 
minutes to render an adult dog insensible to pain. M. Bouis- 
son has tried acetic ether in surgical operations on man, but 
did not obtain such prompt results as with sulphuric ether. It 
required twenty minutes to produce insensibility in a patient 
from whose cheek a small cancerous tumour was excised by 
that surgeon. He thinks that this ether is suitable for persons 
who are easily affected by anaesthetic agents, and that it pro- 
duces less coughing than the sulphuric ether. M. Chambert 
agrees with M. Bouisson in this opinion. 

Nitrous ether, (nitrite of oxide of ethyle,) density 0-95, boils 
at 16° cent, or 51° F. This ether is a deadly poison, and its 
use must be carefully avoided. M. Flourens has verified its 
poisonous properties by experiments on animals, and a servant 
maid of a druggist was killed by sleeping in a room where a 
carboy of it was broken under her bed. — (Ed. Med. and Surg. 
Journal, t. xxxv., p. 452.) This etherial fluid, of course, is to 
be thrown out of the list of anaesthetic agents. 

Nitric ether (nitrate of ethyle) has been used in experiments 
on man and animals, by Dr. Simpson, who declares that it pro- 
duces anaesthetic effects on man when fifty or sixty drops of it 
are inhaled from a handkerchief. He regards it as free from 
danger. But this is not a reliable opinion, for severe headache 
and vertigo follow its inhalation, as I know, and from my ex- 
perience I would not recommend its trial. In case it were 
breathed too freely, I have no doubt it would produce fatal 
results. I therefore reject it. 

Aldehyde (hydrate of the oxide of acetyle) was proposed by 

1853.] Jackson, on Anesthetic Agents. 19 

M. Poggiale, Professor of Chemistry in the Yal-de-Grace in 
1848, as a substitute for ether and chloroform. He had tried 
it on animals, with what he regarded as successful results ; but 
experiments made by others, on men, proved that it was a very 
disagreeable, if not a dangerous substance. Dr. Simpson found 
that it produced a severe cough, and great dyspncca and head- 
ache. The same results were obtained by me, in experiments 
on my own person, in 1847, and I at once denounced aldelyde, 
as not being a safe or proper anaesthetic agent. 

Chloride of hydrocarbon (or the Dutch oil) was proposed by 
Dr. Nunnelly, of Leeds, as an anaesthetic agent ; but experience 
has proved that it produces a severe irritation of the throat, 
and is not so good an anaesthetic agent as chloroform. 

Formomethylae is mentioned, by M. Bouisson, as an anaesthe- 
tic agent somewhat between ether and chloroform. It is 
obtained by distilling wood naphtha (esprit de bois) with a 
mixture of diluted sulphurous acid, and per-oxide of manga- 
nese. It is an agreeable aromatic liquid, boils at 42° cent, or 
107° F. It has been tried upon dogs with success, but never 
upon man. Its value cannot be superior to that of sulphuric 
ether, though regarded by M. Bouisson as between ether and 
chloroform ; furthermore, it is a rare and costly substance, and 
is not known in commerce. 

Benzine, produced by the distillation of benzoic acid with lime, 
has been proposed as a substitute for ether and chloroform, but 
it has proved unsuccessful in the hands of Drs. Simpson and 
Snow, who first proposed to employ it, and it should not be 
used in operations on man. 

Bi-sulphuret of carbon is obtained by passing the vapour of 
sulphur over red hot charcoal, and collecting the volatile pro- 
duct in pounded ice, and then re-distilling it, and condensing 
it again in ice and water. This very disagreeable smelling 
liquid was proposed by some one in Christiania. in Norway, 
as a substitute for ether. I do not know the name of the writer, 
but the article was published in a Norwegian newspaper, called 
the Morgenbladjn 1848. I immediately undertook a series of 
experiments on this volatile liquid, and found that it did possess 
anaesthetic properties of greater power than chloroform, but 
that its use was not only disagreeable but also quite dari 

20 Norwood, on Veratrum Viride. [January, 

•owing to the remarkable effects of the bi-sulphuret of carbon 
vapour on the circulation, and on the respiratory organs. Its 
effect is very sudden, and a person under its influence is as 
pale as ashes, and his lips are of a blue colour — hence there is 
partial asphyxia. After trying it upon my own person, and 
repeating the trial on one of my pupils, I concluded that it 
would be dangerous to allow the introduction of such a pow- 
erful agent into general practice. Its use cannot be safe in 
any but the most skillful hands, and even then I should fear 
that fatal results would occasionally take place. It is not re- 
commended by those who have tried it in France. 

From the foregoing resume of all that is known of the pro- 
posed substitutes for ether, I think the reader will come to the 
conclusion which we have long since arrived at in Boston, 
that none of the substitutes that have thus far been proposed, 
have on trial been found to be equal in value, so far as efficien- 
cy and safety are considered, to the preparation originally 
employed by me in my first experiments, viz., the oxide of 
ethyle, or pure sulphuric ether vapor mingled with air. 

We are in no way opposed to improvements upon my 
method ; but the improvements must be proved to be such, 
before we can admit them ; and we are convinced that there 
is little reason to believe that any substitute will be found that 
will, in all the essential requisites, surpass that for which I have 
expressed my preference. 


Veratrum Viride, or American Hellebore. By W. C. Nor- 
wood, M. D., of Cokesbury, South Carolina. (Continued 
from p. 653 of Vol. VIII., N. S.) 

We gave in the No. of this Journal for November last, an 
account of what was known in reference to the effects of 
veratrum viride previous to 1850, of the manner in which 
we used it and of the cases treated with it. This paper might 
be said to contain the experimental process adopted to deter- 
mine its powers in controlling arterial action, and the effects 
witnessed during these inquiries. But, to proceed : We soon 

1853.] Norwood, or Veratrufk Viride. 21 

discovered, to our surprise, that in almost every instance, so 
soon as nausea or vomiting was excited the pulse became slow, 
lull and distinct, the skin cool and often soft and moist, and in 
s bathed in a most profuse perspiration, with entire 
relief of pain in a number of cases and materially mitigated in 
others. The cases in which there was no abatement of pain 
were very few. The mouth and tongue grew moist, breathing 
and expectoration more free and easy, and by continuing the 
remedy, in doses short of the nauseating point, from one to 
three days longer, there would be no return of the symptoms 
in a large majority of the cases in which the disease was sub- 
jected to early treatment. In a small number of cases, if not 
continued longer, the symptoms would return on a suspension 
of the remedy. In very few cases we have had to continue 
the tincture from five to twelve days. These cases are exceed- 
ingly rare, and were often treated with other remedies or 
suffered to run some time without any treatment. We had, 
by a continued if experiments and observations, arrived 

at the fact that, in nearly every case, we could reduce the pulse 
to any point we wished ; that by putting the patient under its 
influence, we could predict with certainty that the pulse would 
range between 50 and 85 beats per minute. 

Before going any further, we beg leave to present the fol- 
lowing two cases of pneumonia — the one on account of the 
interest of the occasion, and the other because of the peculiar- 
ity of the effect : 

In 1S40, we were called to see Mr. E., in consultation with 
Dr. J. A. Stewart. Mr. E. had been laboring under a severe 
attack of pneumonia for several days. The remedies pre- 
scribed were entirely approved of and continued for a time, 
but failed to relieve. The threatening aspect of the case was 
such, that it was thought prudent to inform his parents, at a 
distance, of his perilous condition. At this critical juncture, 
we observed to Dr. S. that we had been using an article in a 
number of cases of pneumonia, with a success and peculiarity 
of effect we had never been able to obtain from any other 
remedy, and proposed to use it in the present case. We im- 
mediately put Mr. E. on the use of the veratrum viride, to be 
y three hours — the quantity to be increased one drop 

X. 3. VOL. IX. NO. I. 2 

22 Norwood, on Veratrum Viride. [January, 

at each dose until nausea or vomiting occurred. At 8 o'clock, 
A. M., commenced with seven drops. The third portion ex- 
cited severe nausea and free vomiting, with great paleness, 
coolness and moisture of the surface. During the occurrence 
of these interesting and striking effects, we were notified that 
Mr. E. was vomiting freely, was much worse and was thought 
to be dying. We found, however, that what had caused so 
much alarm to the patient and his friends, was to us a source 
of gratification ; for, after the effort at vomiting was over and 
nausea relieved, the pulse was reduced to 63 beats and the pain 

In this case, a pulse of from 120 to 130 beats, was reduced 
in twelve hours, to 63, and all the febrile and inflammatory 
symptoms were relieved. This was to us an occasion of thril- 
ling and exciting interest. Dr. S. was the first physician to 
whom we had stated our belief in its powers, and he now 
stood before us witnessing the most commanding demonstra- 
tion of the powers of the agent over a disease of acknowledged 
fatality and under the most unpromising circumstances. Who 
would charge us with wanton enthusiasm? or who would fail 
to be enthusiastic on such an occasion ? The portion was re- 
duced to one half and continued several days without any return 
of the symptoms, and the patient rapidly convalesced. 

We were at one time impressed with the belief that nausea 
or vomiting, one or both, was essential to the control of the 
heart. Called, in February, 1847, to see a son of Mrs. T., la- 
bouring under a violent attack of pneumonia, we put him on 
the use of veratrum viride every three hours. Although 12 
years of age, his general slender health and deformed chest, 
having been severely afflicted with asthma, induced us to com- 
mence with a very small dose, that we might avoid any drastic 
effect of the remedy. The first portion given was two drops, 
to be increased one drop every portion until the slightest nau- 
sea was experienced, then to lessen or discontinue the remedy, 
as the case might require. On taking the third or fourth por- 
tion, Mrs. T. discovered that he was getting very pale, that the 
skin was cool and moist, and the pain scarcely felt only on taking 
a full inspiration. The slowness of the pulse, and the palor 
and coolness of the surface alarmed her, and she sent for us. 

1853.] Norwood, on Veratrum Viride. 23 

We found him pale, cool, moist, and with a pulse beating 35, 
full and distinct. When put on the tincture, in the morning, 
Ins pulse was 120 to 125, skin hot and dry, frequent and labor- 
ed breathing, pain severe, great thirst. In the short space 
of twelve or fifteen hours the symptoms were subdued, and by 
continuing the tincture in doses of from two to three and four 
drops, there was no renewal of the symptoms. 

Since the above, we have been able, in a number of cases, 
to succeed in reducing the action of the heart and arteries, 
without exciting the least nausea or vomiting, by commencing 
with a very small dose. Nausea and vomiting are therefore 
not absolutely necessary. We might enumerate many other 
cases of like success, but deem it unnecessary to detail any 
more at present. 

In 1850, we determined to announce to the world the fact, 
that the ™reat desideratum had been discovered : an agent by 
which we could emphatically say to the heart and arteries, thus 
fast shalt thou beat, and no faster. Aware of the fate of ma- 
ny remedial agents urged upon the attention of the profession, 
and which have proved valueless, we withheld our notice until 
we had, by the utmost care and observation, acquired the con- 
viction of its being as much a specific in pneumonia typhodes, 
as quinine is in intermittent fevers. We leave it to an enlight- 
ened profession to judge whether or not the agent has failed 
to answer or equal the representations made. 

We now began to reflect upon the fact, that in a very large 
majority, if not in every disease of violence, a frequent pulse is 
manifest, and that we judge, in a great measure, of their inten- 
sity, by its frequency and the condition of the vascular system. 
We asked ourselves the question: if veratrum viride will control 
arterial excitement, break up and arrest pneumonia tvphodes, 
why should it not succeed in arresting other fevers and inflam- 
mations? Believing, as we did, that the altered and vitiated 
condition of the secretions were the consequence of increased 
and perverted circulation, and that the degree of their morbid 
condition might be measured by that of the vascular system, 
we concluded that the veratrum viride would cure other febrile 
and inflammatory affections by its specific action on the heart. 
We were therefore led to test the veratrum viride in a number 

24 Norwood, on Veratrum Viride. [January, 

of diseases, and the result of a limited portion of our experience 
was given in the January numbers of this Journal, for 1851 
and 1852. 

In nearly all, if not in every acute disease, especially of a 
febrile and inflammatory character, we find the frequency of 
the pulse and the derangement of the vascular system in pro- 
portion to the force and severity of the case. There is scarcely 
an exception to the rule. Why this is so we do not know. 
The fact cannot be denied ; and in order to restore health, we 
must, of necessity, control the circulation, directly or indirect- 
ly. Now, veratrum viride will almost invariably effect this, 
whatever may have been the disturbing cause. The how and 
the why, we do not understand. We look upon the universali- 
ty of its application to be exactly defined by the universality of 
the occurrence of increased cardiac action. In testing its 
powers, we did not confine our experiments to febrile and 
inflammatory diseases of an idiopathic character, but extended 
them to traumatic lesions in which fever and inflammation had 
supervened, and our labors were crowned with a success that 
we little dreamed of realizing. Its power of controlling arteri- 
al action, in febrile and inflammatory diseases and in traumatic 
lesions, we consider established beyond doubt. We gave the 
statement of a case of convulsions, treated with the veratrum 
viride, in the January No. (1851) of this Journal ; since which 
time we have treated a number of others, with great success. 
We have not used it in epileptic convulsions sufficiently to 
enable us to speak with confidence and certainty in that dis- 
ease. In the case of a Mr. S., whom we commenced treating in 
January last, and still have under treatment, there has been no 
return of the paroxysms since then, which is a much longer 
interval than he has enjoyed for years, and his general health is 
much improved. It stands unrivalled in palpitations of the 
heart, for promptness and certainty of relief. It is a specific in 
the painful affection of the testicle consequent upon the mumps. 
We have not failed, in a single case, to obtain relief from the 
pain and fever in twelve hours, and prevented a return of the 
symptoms, by perfect rest and a continuance of the tincture 
for three or four days. How far it will succeed in orchitis, from 
other causes, we are not prepared to say. It affords us no ordin- 

1853.] Norwood, on Ycratrum Vivid*. 25 

ary pleasure, to record its value in the treatment of the inflamed 
mamma of lying-in females. If taken in time, in these cases, it 
may be relied on to control the fever, pain and inflammation of 
the gland, so as to prevent suppuration in almost every instance. 
It is valuable in inflammation of the brain. In hooping-cough, 
accompanied with high febrile excitement, it has no equal. In 
convulsions generally, it is highly valuable. In asthma and 
rheumatism its effects are peculiarly striking, especially in the 
acute forms. In chronic rheumatism we have not used it. In 
puerperal fever our experience is limited, but the few cases 
in which it was used stamps it a reliable agent in that dis- 
ease. We have found it of great value in the treatment of 
typhoid dysentery, and would feel unable to combat that dis- 
ease without it or some other remedy of equal power. Its 
eifects on the system are in perfect antagonism to those of 
scarlet fever. Combined with the diuretic treatment, we do 
not believe it can be equalled by any other plan of treatment 
that has ever been adopted in scarlet fever. We know it to 
be valuable of itself, but its powers are greatly increased by 
the above combination. 

When we reflect upon the power of veratrum viride to allay 
pain, irritability and irritation, and more especially irritative 
mobility, in connection with its influence over the heart's ac- 
tion and deranged secretions, it is truly difficult properly to 
appreciate its value. We know of no untried agent that we 
would venture to rely on with more certainty in the treatment 
of yellow fever, and we look with interest for the results of its 
trial in this disease. From its direct influence over the vascu- 
lar system, we believe it will prove valuable in the treatment 
of small-pox, and by keeping the excitement down and the 
surface cool and pale, it will perhaps prevent the unsightly 
pitting which often takes place in that disease. Our remarks 
will be concluded in the next, which will embrace the treat- 
ment of typhoid fever. 

Abbeville C. H., S. C, Xovember, 1852. 
Our last contained a statement of the valuable results ob- 
tained in the treatment of Pneumonitis, and a brief notice of 
the tact that the reduction and control of the heart and arter- 

26 Norwood, on Veratrum Viride. [January, 

ies were not the consequence or result of the nausea and vom- 
iting, but were independent of either of these ; also a notice 
of a number of diseases in which we had tested its value. We 
must confess, that notwithstanding the time and space already 
occupied, that we have scarcely entered the threshold, much 
less exhausted the subject. It would take a volume to unfold 
the powers and effects of veratrum viride, and the almost in- 
numerable cases to which it is peculiarly applicable. The 
powers and properties of veratrum viride, when fully known 
and understood, will open new fields for thought and investi- 
gation, and give greater scope for practical research in all that 
relates to the pathology and treatment of disease, than any 
agent that has ever enlisted the attention of the medical world; 
and we are persuaded that it will completely change many of 
the existing views of pathology, and simplify the treatment of 
disease to an extent unparalleled in the history of medicine. 
Then, as a matter of course, my feeble pen is not equal to the 
task of embodying in a few short essays, written at numerous 
and interrupted periods, snatched from professional exactions, 
all that might be necessary to. a full knowledge and understand- 
ing of its powers. The articles will therefore be clogged with 
numerous repetitions and unavoidable tautology. 

We now enter on the most important and interesting part 
of our subject, viz — its value in the treatment and cure of 
Typhoid Fever — a disease whose fatality renders big with in- 
terest any thing proposed for its cure. The treatment of 
typhoid fever is a matter in which every individual is deeply 
interested. Might we not ask with emphasis, what country, 
what community, has not felt and heard of the destructive 
mortality following in its wake? and has not the cry been 
echoed back by every tongue and breeze — a remedy to stay 
the fell destroyer's progress ! When we have presented as 
much of facts and evidence as we deem sufficient on the occa- 
sion, you will be able to judge and others can determine whe- 
ther a cure has been discovered and the destroyer stayed or 
merely checked ; when the value of veratrum viride in pneu- 
monia typhoides and other malignant and fatal diseases, is 
embraced in the subject, it becomes doubly interesting and 
important. In 1850 we first entered on a trial of the tincture 

1853.] Norwood, on Veratrum Viride, 27 

of veratrum viride in the treatment of typhoid fever. It was 
due to our patients and to justice that we should proceed with 
caution. We accordingly, at first, gave it in mild and moder- 
ately severe cases, avoiding its use at first in all cases of unusual 
severity and malignancy. We first used it in the case of a 
negro boy of Mrs. W., which was uncomplicated and yielded 
readily. When called, on the third day of the disease, the 
bowels had been moved sufficiently by a cathartic of calomel, 
followed by repeated portions of camphorated Dovers powder, 
without abatement of the symptoms. The skin was hot and 
dry, great thirst, severe pain in the forehead ; the eyes dull, 
heavy and ecchymosed ; tongue covered in the centre with a 
dark, thin fur, tip and edges very red and dry ; pulse 127, small, 
soft and with a quickness in the stroke, that indicated greater 
frequency than really existed. The patient was ordered a six 
drop dose, to be increased till nausea or vomiting occurred. 
By mistake, the dose was not increased. After continuing the 
treatment twelve hours, there being no abatement in the symp- 
toms, we were notified of the fact and wrote to increase until 
an impression was made and that we would see the patient in 
twelve hours. During the absence of the messenger, Mrs. W. 
discovered that the dose was to be increased, and did so, and 
when this reached eight drops there was free vomiting, with a 
subsidence of all febrile symptoms, the severe pain in the head 
excepted. At the expiration of twelve hours, we found the 
boy with a skin cool and most, thirst materially abated, and the 
pulse reduced to fifty-six beats. A blister was applied to re- 
lieve the unmitigated pain in the head, and the veratrum viride 
was continued four days without any return of the symptoms. 

Other mild cases were treated with the same rapidly favora- 
ble and successful results. We were thus emboldened and 
warranted in extending it to the treatment of cases much more 
severe and malignant, as were those of Mr. II., the son of Mr. 
W r ., the two at Dr. Q.'s, and that at Dr. T.'s— all of which, 
except the first, were published at length in the January No. of 
this Journal in 1851. 

While on a visit to Georgia, in July. 1851, we were asked 
by Dr. M. to look at a negro woman of Mr. T.'s. She had 
been sick a number of days, with no abatement of the symp- 

28 Norwood, on Veratrum Viride. [January, 

toms. Pulse 116, skin hot and dry, tongue red and dry, great 
thirst, more or less delirium, and a peculiar nervous motion, or 
more properly, a tremor and inability to hold the head still or 
to take a drink of any thing out of a cup or tumbler with her 
own hand. The owner was exceedingly uneasy about the 
condition of his negro, as a great many had fallen victims to 
that disease. We might have noticed the gurgling noise, sick- 
ness at the stomach, and spinal tenderness, which had resisted 
the use of blisters to the stomach and spine, as well as cupping 
of the same, together with an alterative treatment of calomel. 
On being asked our opinion, we observed to Dr. M., we 
thought the fever could be cooled and the pulse reduced. By 
request, we remained five hours, put her on the use of the 
tincture of veratrum viride — gave her seven drops at 12, eight 
at 2, P. M., and nine at 4, P. M. In half an hour after the 
the third portion nausea and vomiting were excited moderate- 
ly. The pulse was reduced to 80 beats per minute, the skin 
became cool and moist, and the nervous tremor or motion very 
much relieved. The Doctor observed, that the pulse was re- 
duced as low as he wished it ; the dose was consequently re- 
duced to four drops, to be given every three hours. A son of 
Mr. T. was also sick of typhoid fever. His case was mild, 
the pulse at the highest numbering but a very few beats over 
one hundred. When the effects on the negro woman were 
known, he was quite anxious to take it also. Accordingly, he 
was ordered it every three hours, beginning with seven drops ; 
to be increased one drop. The third dose excited severe 
nausea and free emesis, producing cool and moist skin, and re- 
ducing the pulse to 58 beats per minute. The portion was 
then reduced to four drops, at intervals of three hours. The 
next morning, at 9 o'clock, found the negro's pulse 80 ; delirium 
entirely gone, and full relief of all nervous tremor; skin cool 
and moist ; tongue moist, and little or no thirst. The son's 
pulse was from 58 to 60, other symptoms in unison. 

The above was an occasion of interest and solicitude to us, 
for the time, and our feelings can be much better imagined 
than expressed. Dr. M. dismissed the cases within thirty hours 
after we first saw them, the medicine to be kept up for a few 
days, and he to be notified in case of change for the worse. 

1853.] Norwood, on Veratrum Viride. 29 

Dr. W. saw them, and Dr. S., then a student, was also present. 
Dr. W. has since used the veratrum viride extensively, and 
with great success. This circumstance led to its introduction 
into that region, Coweta, Troup and Heard, as Dr. M. practiced 
in the three counties. The letters of Dr. M., Dr. Ridley, 
and Dr. Renwick, are testimonials of their opinions of its value 
and beneficial effects in the treatment of typhoid fever, &c. 

We were called, with Dr. P., to see a negro girl of Judge 
B.'s, on whom he was attending. The girl was severely sick 
with typhoid fever, which had been unusually fatal in that re- 
gion. The pulse was from 120 to 130, when at the highest; 
tongue dry, and red on edges and tip, dark brown or black in 
the centre ; great tenderness of the abdomen ; gurgling or 
rumbling and tympanitic abdomen; decubitus on the back; 
feet drawn up ; knees separated ; muttering and delirious while 
inclining to sleep, especially during the night ; tendency to 
diarrhoea ; tip of the nose peculiarly sharp cr pointed — had 
been treated with calomel, turpentine, and camphorated Do- 
ver's powder. It was on the eighth day we saw her, and, with 
desire of Dr. P., commenced giving the tincture every three 
hours. The patient being ten or eleven years of age, we com- 
menced with two drops, and increased each dose one drop. 
In thirty hours the pulse was reduced from 120 to 90 beats per 
minute, surface became cool, and mouth and tongue moist. In 
fifty hours the pulse was reduced to 70, at which time she was 
nauseated and vomited — -it was kept at between 75 and 85, till 
she was fully convalescent, and did not exceed that point, un- 
less suspended, or given at too great intervals. 

The Judge observed, after we had been in attendance for a 
few days — "you say she is better, and will get well. I have 
had two to die in my family already, and she will die also." 
We are pleased to say that we were correct in our prognosis, 
and that when we left, the patient was sitting up and able to 
walk about, had a good appetite and regular bowels. This was 
a case of no ordinary interest, as in that immediate section 
many had denied the elficacy and the powers of the veratrum 
viride, but had witnessed the mortality of the disease under 
every other mode of treatment. This closes the history of 
three cases we assisted in treating in Georgia. We will again 

30 Norwood, on Veratrum Viride. [January, 

turn to our own, and an adjoining district, and give the cases 
of most interest. 

On the 14th July, 1852, we saw, in consultation with Dr. C, 
Mr. C. It was the sixth day of his relapse. Pulse 120, small, 
soft and weak ; gurgling on pressure, and tenderness in the 
right iliac region ; bowels flatulent and slightly tympanitic ; 
burning in the palm of the right hand ; edges and tip of tongue 
dry and red — slight white fur on the tongue, which we attribu- 
ted to calomel ; preternatural wakefulness. Had been treated 
with alterative doses of calomel and Dover's powder — had ta- 
ken an emetic. Gums slightly distended from calomel, fetid or 
mercurial breath, and a number of small ulcers on the cheeks 
and tongue; skin dry ; bowels inclining to diarrhoea, but readi- 
ly controlled. By consent, was put on the tinct. of veratrum 
viride every three hours, to be increased slowly, and to avoid 
emesis, as he was opposed to taking it till it produced this effect. 
This is a great error ; for those who take it till free emesis is 
excited, and the liver properly aroused, convalesce much fast- 
er. Commenced with three drops, and increased one drop 
every portion given, till six were taken, and slight nausea pro- 
duced. It was then reduced to three drops, or more, accord- 
ing to effect. On reaching six drops, the pulse was reduced to 
80, and kept from 80 to 85. By continuing this treatment for 
a number of days, the pulse was reduced as low as 70 in the 
morning, with the skin rather cooler than ordinary, and to- 
wards sun-set it would get up to 80 or 85, and the skin would 
be rather warm, and accompanied with more or less restlessness 
till midnight, and then pass off. It was suggested to try a few 
portions of quinine. The morning on which he took the 
quinine, the pulse was 70, skin cool, mouth and tongue moist. 
A portion of quinine was given at 9 and 11. Before 1, his 
pulse was from 130 to 135, the skin hot and dry, and a general 
aggravation of all the febrile symptoms. The veratrum viride 
was resumed in full portions for a few doses, which soon sub- 
dued the excitement, and was continued. Convalescence was 
slow but perfect. It is an error, not to reduce the pulse as low 
as sixty in many cases. There is as much febrile excitement 
in some, with a pulse of 80, as there is in others with a pulse of 
90 or 100 ; consequently, when this is the case, the convales- 

1853.] Norwood, on Veratrum Viride. 31 

cence will be extremely slow. In such cases, the veratrum 
viride should be given till free emesis is excited, and the pulse 
should be kept at 60 or under. 

On the 19th July, 1852, we were called into an adjoining 
district, to see a negro woman of Mrs. G.'s, in consultation 
with Drs. T. and McD. We saw her at 8, A. M., on the 20th, 
the twelfth day of the disease. She had been treated with all 
the remedies usually resorted to, without relief. She was 
slightly mercurialized ; supposed to be three months advanced 
in pregnancy ; pulse 130, extremely quick and weak, so much 
so that it was difficult to count ; tongue dry and red on the tip 
and edges, with a thick dark fur in the centre. The papillae 
were not covered with fur, were elevated, enlarged and flatten- 
ed at top ; thirst extreme ; great heat in the region of the sto- 
mach, and complaining of internal heat and burning ; extremities 
cold, with general coolness of the surface, except over the re- 
gion of the stomach ; answered questions in a quick and hurried 
manner — would invariably change some part of the body before 
giving an answer. Discharges from the bowels dark and 
muddy, mixed with slime ; more or less tenderness and gurgling 
on pressure in the right iliac region ; tendency to diarrhosa 
slight. On the ninth day from the attack, there was a sudden 
and decided change for the worse, and brandy and quinine 
were freely given to sustain the action of the heart and arte- 
ries, and the surface was thoroughly rubbed to keep up external 

We have given such a description of the treatment and con- 
dition of the patient, at the time of our first visit, as will be fully 
endorsed by the physicians in attendance. Two cases had 
just terminated fatally in the same family, and two others in a 
family not more than six hundred yards distant. We could 
not complain of the reputation that had preceded us ; but the 
standing of the medicine was anything but favorable in that 
region of country. The previous and threatening mortality, 
the severity of the case, the new remedy, the unfavorable prog- 
nosis of the physicians in attendance, naturally excited the 
deepest interest, and curiosity was wrought up to the highest 
point as to what course would be pursued. By consent, every 
remedy was discontinued, both internal and external, and the 

32 Norwood, on Veratrum Viride. [January, 

tincture of veratrum viride ordered every three hours, to be 
increased pro re nata, which we superintended in person from 
9, A. M. till 5 P. M. Three drops were given at 9, which 
nauseated and vomited pretty freely before 12. The first mat- 
ter thrown up was a large quantity of mucus and slime, follow- 
ed by a quantity of dark, thick bile, or bitterish fluid, on the 
ejection of which she expressed considerable relief from the 
unusual burning or heat in the region of the stomach. Four 
drops were given at 12, which excited free emesis in from 
thirty to fifty minutes, bringing up an abundance of thick, yel- 
low bile. After this paroxysm of vomiting had subsided, the 
extremities and surface generally became warm, or, in other 
words, there was a general diffusion and equal distribution of 
heat She expressed perfect relief from internal heat or burn- 
ing, followed by a general feeling of agreeable coolness ; but 
three drops were given at 3 o'clock, which excited slight 
nausea, and perhaps a slight but single paroxysm of vomiting. 
What we had achieved when we left (at 5, P. M.) was the re- 
lief from unusual heat in the stomach, severe thirst, general 
restlessness, an equable diffusion of heat, and greater fulness 
and distinctness of the pulse. Instructions were left to continue 
the veratrum viride in three or four drop doses, as she might 
be able to bear it, avoiding too much nausea and vomiting, if 
possible. After leaving, we sent a message back to give twenty 
or thirty drops of laudanum, one hour before the next portion, 
to prevent nausea or vomiting, if possible. 

That night, as matter of course, was passed by us with more 
or less anxiety and interest. On reaching the patient the next 
morning, the viride was exciting very little nausea, the pulse 
was reduced to 120, more full and distinct, and all the other 
symptoms were slightly improved. We were not satisfied 
with the small quantity of the veratrum viride we were using ; 
w T e therefore ordered an enema of four ounces of cold water 
and six drops of the tinct. of veratrum viride every six hours, 
and the three drop doses, every three hours, to be continued, 
thus making, in all, forty-eight drops in the twenty-four hours. 
The enemata were ordered to be given between the portions 
by mouth. The nausea and vomiting were kept up for a time 
after each enema, but not to an extent that required them to be 

1853.] Norwood, on Veratrum Viride. 33 

suspended, and which subsided after a few repetitions of the 

The morning following, which was the fourteenth day of the 
disease, the pulse was down to 100, and with a like improve- 
ment in all the symptoms. The morning following, the pulse 
was reduced to 85, and all the other symptoms were greatly 
mitigated, so much so that we were not to see her for the next 
forty-eight hours. On Sunday morning, at 9, A. M., (the 
seventeenth day of the disease,) we were at our post, with our 
pleasing anticipations disappointed, blasted, and, for the time, 
scattered to the winds, — >but to fight the battle at far greater 
hazard. Found her flooding ; pains severe and frequent. Re- 
quested Dr. T. to examine the condition of the uterus; found 
the os tineas soft and dilated, so that he could discover a sub- 
stance or body presenting; gave her a portion of ergot; the 
fetus was thrown oft' within a half hour, and flooding ceased. 
By this time the pulse had reached 135 beats per minute, was 
peculiarly quick and feeble ; number of respirations 63 per 
minute ; skin hot and dry, the heat of that peculiar acrid kind 
called " calor mordax ;" thirst greatly aggravated. The vera- 
trum viride was increased to five drops every three hours ; 
spirits of turpentine to be given every six hours, in fifteen drop 
doses, in a little warm sweet milk to cover the taste, which 
excels any vehicle we ever tried. The enema of cold water 
to be continued every six hours, and the viride increased to 
eight drops. When we left, at 4 in the afternoon, there was 
slight moisture of the surface ; the pulse was 130, more full and 
distinct ; breathing a little less frequent and hurried. On the 
day following it was reduced to 95 beats per minute; on the 
following day it was reduced as low as 85, with alike improve- 
ment of all the symptoms. The remedies were continued, and 
she rapidly and perfectly convalesced. It did appear that 
Frovidence brought us safely through the most critical of all 
the cases we have met. It also appeared, that so soon as the 
foetus was thrown off", she was much less susceptible to the im- 
pression of the veratrum viride. 

There are many points of interest in the above case, which 
are well worthy of particular notice. In the first place, it had 
been treated by two skillful physicians, with all the ordinary 

34 Norwood, on Veratrum Viride. [January, 

remedies. On the ninth day, the stage of collapse or exhaus- 
tion set in so rapidly and to such an extent, as to render brandy, 
quinine and rubefacient frictions necessary, to keep up the ac- 
tions of the heart and arteries as well as the external warmth. 
After the free use of the above, from Saturday till Tuesday, 
we find there was no relief, but rather a continuance and ag- 
gravation of the symptoms. On Tuesday there was a with- 
drawal of all remedial agents in use — was put on a few drops 
of the tincture of veratrum viride, at no time for the first 24 
hours exceeding four drops. This was attended with relief 
from internal heat and burning, a general distribution of heat 
on the surface, and the pulse rendered slower, fuller, and more 
distinct, &c. The only change made which seemed to add to 
the good effects, were enemata of cold water, containing six 
drops of the tinct. of veratrum viride. In the meantime she 
aborts with a renewal and aggravation of all the symptoms ; 
to meet which, there is added to the treatment 15 drops of spts. 
turpentine ; the dose of veratrum viride increased, by mouth, 
to five drops, and by enemata to 8 drops. Again, the lessened 
susceptibility after the abortion, whereas, under ordinary cir- 
cumstances, bleeding increases this susceptibility : true, the 
loss of blood was comparatively small, yet, taking into account 
the length of time she had been sick, it might be said to have 
been relatively large. These are facts and circumstances for 
reflection and investigation. 

We had intended to report three severe and interesting cases 
treated in the same family, but the continual appearance of 
articles from other and abler pens, induces us to lay aside much 
that we intended for the press. We will simply state that, with 
the prompt and efficient assistance of the two physicians in 
attendance, we were able to bring all the cases to a happy ter- 
mination. We will add, for the sake of brevity, that all the 
cases were treated previous to January, 1852, except a very 
few. Since the first of June, 1852, w« have been called to see 
seven cases of typhoid fever, in consultation, all of which were 
cured. We had noted down eleven consecutive cases of this 
fever, eight of which we saw in consultation, one had been 
seen by another physician and two were seen by no other phy- 
sician. We notice these on account of their great severity, 

1853.] Norwood, on Veratrum Viride. 35 

and more especially from the fact of a large majority of them 
being patients under treatment by other physicians. We are 
in possession of a large number of cases of typhoid and other 
diseases, which have been treated with unvarying success with 
the veratrum viride. Dr. B. treated 23 cases, without the loss 
of a single one — all in the same family. 

Veratrum viride, green hellebore, American hellebore, is not 
our common Poke-root or Phytolacca Decandra, but is the 
poke weed, veratrum viride, and is entirely different in its ap- 
pearance and properties. Again — it is called white hellebore, 
by the shakers, and those ordering the veratrum viride often 
get the white hellebore proper, or European, for it, by not 
being specific in the correction of the error in name. The 
properties and powers of veratrum viride are the following : 
1st, acrid — This property is very limited and confined to the 
fauces. 2d. Tt is adanagic, deobstruent or alterative : this pro- 
perty it possesses in a marked and very high degree ; not 
equalled by calomel or iodine in this particular, which will 
adapt it to the relief and cure of many diseases hitherto beyond 
the reach of any remedy. Of this class of diseases, those 
which we think will be much benefitted by it, are, cancer and 
consumption. 3d. It is actively and decidedly expectorant, so 
much so that we rarely add any other article. 4th. It is one 
of the most certain diaphoretics belonging to the materia med- 
ica: it often excites great coolness or coldness of the surface ; 
in some cases the skin is rendered merely soft and moist; in 
other instances, the perspiration is free, and at other times it is 
most abundant ; but, notwithstanding its profuseness, it does 
not reduce or exhaust the system, as many diaphoretics do 
when in excess, and therefore need not excite alarm nor be 
suspended on that account. 5th. It is nervine, not narcotic, 
under any circumstances ; as since our first article, we have 
taken it more than twenty times to test its varied powers, and 
we have taken it in all quantities, from the production of free 
emesis down to the minimum dose. This property renders it of 
great value in the treatment of painful diseases and such as are 
accompanied with convulsions, morbid irritability and irritative 
mobility. For example — pneumonia, rheumatism, puerperal 
fever, convulsions generally, and palpitation of the heart, &c. 

36 Norwood, on Verairum Viride. [January, 

6th. It is one of the most certain and efficient emetics known, and 
is peculiarly adapted to meet that indication in hooping cough, 
asthma^ croup, scarlet fever, and in all cases where there is 
much febrile and inflammatory action. It often excites severe 
nausea and frequent vomiting, which, taken in connection with 
great paleness* often alarms the patient and by-standers ; but 
these effects, when in excess, are readily relieved by one or two 
full portions of morphine and tinct. of ginger, or of laudanum 
and brandy. One grand and leading feature is, that the ex- 
haustion which follows it, is not excessive and permanent, but 
confined merely to the effort. Again, the matter, first ejected, 
is a large quantity of thick, slimy mucus, and soon after, the 
liver is called on to pour forth its own fluid in abundance. 7th. 
The seventh property is its most valuable and interesting, and 
for which it stands unparalleled and unequaled as a therapeutic 
agent. So much has already been written on what we call the 
sedative — arterial sedative — properties of the agent, or the 
power it possesses of controlling and regulating arterial action, 
that we shall not again run over the amount of evidence on this 
part of the subject. By virtue of this and other powers, the 
treatment of disease has been much simplified, and when the 
effects, recorded in the case of Mr. G.'s negro woman, shall 
have been fully considered, we may bid adieu to much of the 
supposed necessity for stimulants in the treatment of atonic or 
-asthenic cases. We challenge the medical world to produce 
its equal, as a therapeutic agent, for certainty of effect, for ex- 
tent of effect, or for peculiarity of effect, and the ease and 
safety with which it may be administered to small and great. 
In small portions, we have found nothing to equal it in exciting 
and promoting appetite. 

The formula we use is the following : — 

#. Root of veratrum viride, dried, . . oz. 8 
Alcohol, of the shops, undiluted, ... i: 16 
Let it stand from ten days to two weeks. Medium dose for an 
adult male, eight drops, to be increased one or two drops every 
portion, until nausea or vomiting, or a reduction in the frequen- 
cy of the pulse takes place; then reduce one-half in all cases. 
Females, and persons from 14 to 18 years of age, should com- 
mence with six drops, and increase as above. Children, from 

1853.] Norwood, on Veratrum Viride. 37 

one to two years of age, to commence with one chop ; from two 
to five years of age, two drops, and increase one drop. The 
usual interval with us is three hours between the portions. In 
ordinary cases of pneumonia, we usually continue it three days 
after the symptons are subsided. In typhoid fever, and many 
other diseases, it requires to be continued much longer. For 
the satisfaction and information of the profession, we would 
state that it may be continued indefinitely, or any length of time, 
in moderate doses, or short of nausea, without the least incon- 
venience. The only objection that could be urged, is the 
increase of appetite, or desire for food. It is not cathartic — 
it is like all other remedial agents, subject to the same rules 
and regulations, making it out of the question for a person to 
lay down any but general directions for regulating the dose. 
We are better pleased with the method adopted for getting its 
first impression by Dr. Welburn, of Farmville, Alabama, than 
with our own. We allude to the short interval between the 
first three portions he administers: He gives "six drops, in ten 
minutes seven drops, in ten minutes more eight or ten drops ; 
and then suspends the dose till vomiting occurs," which will 
be sure to take place in a large majority of cases. In the out- 
set of many cases, we would recommend Dr. Welburn's man- 
ner of using it. In a male, twenty-five drops is the largest 
quantity we have known to be required to excite emesis, and 
sixteen drops in the female when given in the manner and at 
the intervals we have directed. There need be no danger ap- 
prehended of its exciting inflammation of the stomach — we 
have given special attention to that particular. It is peculiar 
and at the same time interesting in its effects. The fact of its 
acting as a sedative on almost every other portion of the sys- 
tem, diminishing the vascular and muscular action and motion 
of every other part, and increasing that of the stomach. We 
have seen it produce emesis in very susceptible persons, and the 
contractions of the stomach were so rapid as to be almost con- 
tinuous and uninterrupted : but a strong alcoholic tincture of 
ginger and morphine would afford more prompt and immediate 
relief than any other articles that we have ever used. We 
have never scon a case that failed to be relieved by the above 
remedies in thirty minutes. The great advantage of the rem- 
x. a. — VOL. IX. no. i. 3 

Norwood, on Veratrum Viride. [January, 

edy is that it does not exhaust longer than the effort to vomit 
is concerned. A great many remedies leave the patient in an 
exhausted and enfeebled condition, aside from the effort or im- 
mediate action — not so with the veratrum viride. Again, tartar 
emetic should never be given with it, in any form or manner. 
The only cases in which we have seen the tincture of veratrum 
viride purge, were when given in combination with tartar emet- 
ic, or with Coxe's hive syrup. In most of these cases it excited 
a violent cholera-morbus. We would not think of giving the 
tincture of veratrum viride where tartar emetic had been used, 
without preceding it with a full dose of morphine or laudanum 
at least one hour. We have known many fall out with the 
veratrum viride when it was not at fault. Again, venesection, 
when a large quantity of blood is drawn, increases materially 
its effects, whereas opium and morphine lessens or diminishes 
them. If a patient had been bled freely, preceded or followed 
by a liberal use of tartar emetic, and then followed up with 
medium portions of the tincture of veratrum viride, we should 
anticipate and prepare for drastic, if not hazardous effects. 

The length of our article warns us of the necessity of con- 
cluding. We will, for the benefit of many who have written 
us, state the diseases in which we have used it with success, 
and leave the matter with the profession for further experiment 
and application from analogy. We do not hazard any thing of 
opinion or reputation, when we assert that it is a specific in 
pneumonia, in the qualified terms we have stated ; we say the 
same of convulsions accompanied with high febrile excitement, 
also of palpitation of the heart. In typhoid fever it has more 
than answered our most sanguine anticipations ; we assert the 
same in puerperal fever, scarlet fever, rheumatism and asthma. 
In the spring of 1851, we were called in consultation with Dr. 
Stewart, to Dr. G.'s child, who was well nigh run down with 
hooping cough, fever and diarrhoea. We advised the tincture 
of veratrum viride, which acted like a charm ; since which 
time, Dr. S. has written us a letter highly extolling it as unpar- 
alleled in the treatment of hooping cough. We have seen no 
ease of metastasis to the testicle in mumps, that was not reliev- 
ed of pain and fever in twelve hours. It may be styled the 
remedy in croup, when there is great vascular derangement. 

1853.] Xorwood, on Veratrum Viride. 39 

We have used it with great success in inflammation of the 
brain, also in typhoid dysentery. It is a valuable emmena- 
gogue. In the inflamed breast, we give it with a confidence 
bordering on a certainty of success. In epileptic convulsions 
we have confidence of obtaining great relief from it. We look 
with confidence to being able to cure consumption, by a timely 
and judicious use of it. We trust even cancer will be robbed 
of its terrors. We are anxious to test its powers in yellow 
fever and in phlegmasia dolens, &c. In conclusion, we will 
state to the profession at large, that we have endeavored to 
give a faithful and unexaggerated account of a portion of the 
cases in which we have used it, with a statement of its powers 
and properties. We know that we have like passions with 
other men, and that we are liable to be mistaken, that we are 
liable to be carried beyond the bounds of truth and soberness, 
as well as others, in our great desire to advance and consumate 
as far as we may, the honor and perfection of our science. 
But we feel confident, that when all is cool and calm — when 
every property and power is put to the test of fair and proper 
trial — that every effect and power claimed by us as belonging 
to and possessed by veratrum viride, will be emphatically con- 
firmed and established by the profession. We have not made 
any effort to distinguish between its primary or direct and its 
secondary or indirect effects. If we have succeeded in getting 
the profession awakened to its properties and enlisted in the 
investigation of its application and adaptation to the treatment 
of disease, we congratulate ourselves that we have achieved 
much with our feeble efforts, and that ere long we shall see 
embodied, by much abler pens, all the inestimable and unpar- 
alleled powers belonging to veratrum viride. 

Columbus, Ga., March 23, 1852. 
Dr. W. C. Norwood : 

Dear Sir — I left home, for Macon, a few days after you. On my 
return, found Dr. BosweU in full blast with the veratrum viride : 
visited his cases with him — have used it in a fe\v*cascs myself, and 
in every case it was sure to reduce the pulse. I am as well pleased 
with it as I anticipated, and as much so as any one remedy I ever used. 
I have no idea that you claim for it as much credit as it is entitled to. 
Four out of the six ounces have been used, and we will soon need 
more. I design extending its use in every case where there is too 

40 Norwood, on Veratrum Viride. [^ anuar y? 

much arterial action, until I have fully tested whether there be a dif- 
ference in its effects in different diseases. 


[We regret, that we mislaid a letter of later date from Dr, 
B., which was much more full and specific than the above, 
which was written in haste and in answer to other inquiries.] 

Flat Shoals, Ga., Feb. 10th, 1852. 
Dr. Norwood : 

Sir — I avail myself of this opportunity for communicating to you 
the result of my experience in the use of the preparation of veratrum 
viride. * * * But I assure you that the v. viride, as a curative, 
far exceeds any thing with which I am acquainted. I have given it 
in only two cases, and if it proves as successful in the future, I pro- 
nounce it a specific in the fullest acceptation of the term. 

Case 1st. I was called to visit Mr. A. on 5th inst. Found him 
laboring under a deep-seated attack of pneumonia typhodes : he had 
great difficulty in breathing, intense headache, irritable stomach, 
skin hot and dry, pulse 165 to the minute. Commenced giving him 
the v. viride in five drop doses, until he had taken four portions ; then 
increased it to ten drops. By the next day, at noon, his pulse was 
reduced to 85 per minute, skin moist and pleasant, cerebral disturb- 
ance removed. His recovery from this time forward was rapidly 

Case 2d. I was called to Mrs. J., whom I found laboring under 
palpitation of the heart; pulse 130; great anxiety manifested by the 
countenance, and, using her own language, a "sense of suffocation" 
experienced. Ordered the v. viride given in ten drop doses, every 
three hours. The second dose produced free emesis, and with it an 
entire abatement of all distressing symptoms. 

These two cases were treated with nothing else, save the v. viride, 
in order to test its powers in controlling the circulation. I would not 
take $20 for the remnant left, (one ounce,) placing the medicine out 
of my reach. I think, sir, you may safely stake your reputation, as a 
medical man, upon the virtues of your bantling. It is, indeed, the 
" philosopher's stone," and the "blessing of him that is ready to per- 
ish," will be bestowed upon you for the discovery. 

Trusting that you may live long, to seethe success of your medi- 
cine placed beyond the reach of envy or malice, I am, my dear sir, 
your ob't ser'vt, J. J. C. BLACKBURN, M. D. 

Milledgeville, Ga., Jan. 12, 1852. 
Dr. Norwood: 

Dear Sir, * * * I feel perfect freedom in assuring you, that 
I do not know of any article of medicine which manifests itself as a 
reliable remedial agent in any kind of specific action, on particular 
parts of the human system, with half the certainty as your preparation 

1853.] Norwood, on Veratrum Viride. 41 

of veratrum does, in controlling inordinate action of the heart, under 
the varied forma of febrile excitement. Calomel does not act with 
half the certainty, in emulging the liver — nor does aloes, in irritating 
the lower part of the rectum — nor does ergot of rye, in increasing 
parturient effort in labor, and, indeed, 1 might say, nor is tartrite of 
antimony more certain to produce emesis, nor is castor oil, nor croton 
oil, nor any other purgative, more certain to produce catharsis. 

How fur your preparation acts, as a remedial agent, beyond its un- 
paralleled and uncqualed control of the sanguiferous system, in the 
management of fevers of diflcrent types and at different stages — or 
what is its modus operandi in producing such effects as are distinctly 
evident to any observer of common sense, (physician or otherwise,) 
and in seeming to produce very beneficial collateral effects from its 
use in very dangerous cases, at critical times, / am not prepared to 
say. My testimony, as a medical man of some experience, may, 
however, be briefly stated to be decidedly favorable to the use of said 
article, believing, as I do, that no physician can use it without regard- 
ing it as a very efficient article, and such a one as in its specific con- 
trol of the action of the heart, in feverish excitements, fully meets our 
heretofore earnest desideratum. Digitalis succeeds in one case out 
of twenty perhaps — this preparation, in nineteen cases out of twenty, 
more certainly. 

So much, at present, in reference to my appreciation of the use of 
your preparation of veratrum viride. I know that I am sincere, and 
do not think that I am enthusiastic beyond a reliable matter of fact. * 
* * * JOHN F. MORLAND, M. D- 

[The Doctor resides at Corinth, Ga. He was acting mem- 
ber of the legislature when the above was written. — w. c. n.] 

Oglethorpe, Ga., 19th Feb., 1852. 

My Dear Sir — Please pardon me for not giving you, earlier, the 
results of my experience in the use of the veratrum viride. So soon 
as I received the package you sent me, I made the saturated tincture of 
alcohol, and have used it with more certainty of success, in controlling 
arterial action, than any other known remedy. I can truly say, that 
I have never found any remedy that produced its specific effects so 
certainly in my hands — it has never failed. I have used it in scarlet 
fever, pneumonia, typhoid pneumonia, typhoid fever, inflammatory 
rheumatism, and in all cases where I wanted to lessen the frequency 
of the heart's action, and in no instance has it failed. In your pub- 
lished articles you have claimed much for it, but not more, nor as 
much as it really merits ; for if there is any thing in nature entitled to 
confidence, to such a degree as to amount to a certainty, it is most 
undoubtedly the article. I hope the profession will ui adopt 

its use. and thereby secure tor the l triumph 

its, in saving thousands from an untimely grave ; and for you, 1 am 
certain the prayers of thousands will arise to a throne of grace, that 
you may be abundantly blessed in your labors. 

Most respectfully, yours, WILLIAM ELLIS, M. D. 

42 Dugas, on Extirpation of a Cervical Tumor. [January, 

New York, Sept. 22d, 1851. 

At the request of Dr. Norwood, of S. Carolina, in order to test the 
effects of the internal administration of the veratrum viride upon the 
circulation, 1 selected four cases in my wards, and ordered the tincture 
of the root to be prescribed as follows : 

Case 1st. Adult female : extensive fissure of the anus and rectum, 
spasmodic contraction of the sphincter ani, with excessive pain ; 
pulse 130. Dose, five drops every three hours. Pulse reduced to 68 
in fifteen hours. 

Case 2d. Adult male : morbus coxarius; pulse 99. Dose, from 
five to eight drops every three hours. Pulse reduced in twelve hours 
to 50 beats. 

Case 3d. Adult male: articular rheumatism; pulse 120. Dose, 
from five to eight drops every three hours. Pulse reduced to 80 in 
fifteen hours. 

Case 4th. Adult male : the effects of the operation by excision for 
large sarcolated hydroceles of the tunica vaginalis on both sides ; 
pulse 102. Dose, five drops every three hours. Reduction in ten 
hours to 60 beats. 

I should have much confidence in the salutary action of the vera- 
trum viride in cases of acceleration of the pulse in traumatic lesion of 
any of the vital organs, in patients of a robust constitution, or with 
sthenic diathesis. J. M. CARNOCHAN, M. D., 

Surgeon of the New York Emigrant's Hospital ; 
Prof, of Surgery in the N. York Med. College. 


Extirpation of a Cervical Tumor. By L. A. Dugas, M.D., &c. 

Elick, a negro (blacksmith), about 40 years of age, belonging 
to Mr. James McDow'el, of Talbot county, Ga., was sent to me 
in November last, when I obtained the following history of his 
case : — About thirteen years ago he perceived a small tumor 
upon the right side of his neck, a little above the clavicle, which, 
although somewhat tender to the touch, remained without giv- 
ing him any trouble until nine years ago, when he began to 
feel some uneasiness in the right arm, which would be increased 
upon pressing or handling the tumor, then apparently not larger 
than the end of his thumb. The pain of the limb gradually 
became more troublesome until four years ago, since when he 
has been more or less incapacitated for the duties of his trade, 
his sufferings being very much aggravated by working at the 
anvil. For the last six or eight months his entire limb has 

1853.] Dugas, on Extirpation of a Cervical Tumor. 43 

been the seat of incessantly excruciating pain, depriving him 
of sleep, and utterly unfitting him for any kind of work. Sev- 
eral years ago his right hand and arm became very tremulous, 
and this state of things extended to the left arm, and subse- 
quently to the whole muscular system. Several physicians 
were consulted, and pronounced the tumor to be aneurismal. 

Upon examining the case I found it to be as follows : — A 
tumor exists in the triangular space above the clavicle, and 
between the sterno-cleido-mastoideus and trapezius of the right 
side. It appears to be beneath the platysma myoides, presents 
a surface about the size of a half-dollar coin, but evidently ex- 
tends down to the brachial plexus, the subclavian artery and the 
clavicle. It is extremely sensitive to the touch, or rather, when 
touched, intense pain is induced in the brachial plexus and 
down the arm to the fingers. It is very slightly moveable, 
yields a sense of obscure fluctuation, and pulsates visibly as 
well as to the touch, synchronously with the arteries. The 
pulsation is arrested by compressing the subclavian artery 
nearer the heart, but the size of the tumor remains unchanged — 
nor can this be diminished by direct pressure upon the tumor. 
Auscultation reveals no aneurismal sound. General health 
pretty good, with the exception of the muscular tremor, which 
was much increased by the examination. He carries the limb 
in a sling, or holds it up w T ith the other hand, when walking or 
standing ; but when seated, draws the affected arm around the 
back of the chair or bed-post with the left hand, so as to effect 
as much pressure as possible and to keep it steady, by which 
means he says he is partially relieved of the dreadful pain. 
Can use his hand, but cannot elevate the arm — probably from 
protracted disuse added to the nervous affection. He is so 
nervous that he perhaps exaggerates his sufferings. 

Being satisfied that the case was one of diseased lymphatic 
gland, which derived its pulsations from contact with the sub- 
clavian artery, and which irritated, by pressure, the subjacent 
brachial plexus, I proceeded to extirpate the tumor on the 27th 
November, in presence of the Medical Class and others. 

This was effected in the usual manner. The tumor was 
found to be about the size of a large hen's egg, in contact with 
the subclavian artery, and resting upon the brachial plexus, to 

44 Dugas, on Extirpation of a Cervical Tumor. [January, 

which it was connected by strong areolar tissue. It proved to 
be a lymphatic gland, whose investing membrane was thick 
and resisting, and whose structure, broken up by chronic dis- 
ease, presented a mass of shreds and small cavities filled with a 
caseous and grumous matter.* Subjected to microscopical 
examination by Dr. Juriah Harriss, no carcinomatous cells 
were detected. 

The great impairment of the patient's nervous functions, his 
extraordinary timidity and reluctance to submit to what he 
thought would in all probability kill him, and the necessity of 
inducing, for such an operation, the most complete or coma- 
tose anaesthesia for a greater length of time than might be 
safe under the circumstances, induced me to omit the use of 
chloroform or ether. He bore the knife very badly, was ex- 
tremely unruly, and thus protracted the completion of the 
operation much beyond what was necessary. A slight suppu- 
ration ensued, but the wound was perfectly healed on the 12th 
December, and he returned home on the 16th. 

The patient felt no more pain in the right arm after the day 
of the operation, but said there was still some numbness and 
weakness in the limb. When he left here he had so far recov- 
ered the use of his arm as to be able to cut wood with an axe, 
or with a saw, the left hand, however, being much the stronger 
of the two. He could not yet elevate the whole limb — but will 
doubtless regain its full powers by use. 

The rare occurrence of such serious effects from so small a 
tumor in the cervical region, together with the interest attach- 
ed to the case in consequence of a difference of opinion with 
regard to the diagnosis, have induced the writer to put it on 

Augusta, Dec. 1852. 

♦ An account of diseased Cervical Glands was published by the writer in this 
Journal, in 1846, vol. 2, new series, p. 513. 

1853.] On Amputation. 45 

— -i — 

Cclcctic Department. 

What is the best time to amputate? 

[We extract from one of Mr. Guthrie's lectures, published 
in the London Lancet, the following aphorisms in reference to 
the time at which amputations should be performed after 
wounds. The eminent abilities and extensive experience of 
Mr. G. entitle his conclusions to great respect. — Editor.] 

40. When the wound of an extremity is of so serious a na- 
ture as to preclude all hope of saving it by scientific treatment, 
that limb should be amputated as soon as possible. 

41. An amputation of the upper extremity may almost al- 
wavs be done from the shoulder-joint downwards, without much 
risk to life, and when necessary, the sooner it is done the better. 

42. An amputation of any part of the lower extremity be- 
low the knee downwards may be done forthwith, with nearly 
an equal chance of freedom from any immediate danger, as of 
the upper extremity at or near the shoulder-joint. 

43. It is otherwise with amputations above the middle of the 
thigh, and up to the hip-joint. They are always attended by 
considerable danger. 

44. There can be no doubt that if the knife of the surgeon 
could in all cases follow the ball of the enemy, or the wheel of 
a railway carriage, and make a clean good stump instead of 
leaving a contused and ragged wound, it would be greatly to 
the advantage of the sufferer ; but as this cannot be, and an 
approach to it even can rarely take place, the question naturally 
recurs, — At what distance of time after the receipt of the in- 
jury or aecident can the operation be performed most advan- 
tageously for the patient ? 

45. In order to answer this question distinctly, it should be 
considered with reference to two distinct states of injurv: — 

1st. When injuries require amputation of the arm below the 
shoulder-joint, or of the leg below the knee, these operations 
may be done at any time from the moment of infliction until 
the expiration of twelve or twenty-four hours, without any 
detriment being sustained by the sufferer with regard to his 
recovery ; although every one, under such circumstances, must 
be desirous to have the operation over. The surgeon having 
several equally serious cases of injury of the head or trunk 
brought to him at the same time as two requiring amputation, 
may defer them more safely perhaps than the assistance he is 

46 On Amputation. [January, 

also called upon to give to the other cases, the postponement 
of which may be attended with greater danger. 

2nd. This state embraces those great injuries, in which the 
shoulder is carried away with some injury to the trunk, or the 
thigh is torn off at or above its middle, rendering an amputation 
of the upper third or at the hip-joint necessary ; and it is this 
or nearly this state which alone implies a doubt as to the pro- 
priety of immediate amputation, and demands further investi- 
gation. It is the state to which your attention is earnestly 
drawn for future observation. 

46. It has been implied, if not actually maintained, that a 
man could have his thigh carried away by a cannon-shot with- 
out being fully aware of it, or, if aware of it, that it did not 
cause much alarm — in fact, that it did not materially signify 
as to his apprehension, whether the ball took off his limb or the 
tail of his coat, or only grazed his breeches. An instance of 
this kind has not fallen under my observation. 

47. A surgeon on a field of battle can rarely have a patient 
brought to him, requiring amputation, under less time than 
from a quarter to half an hour ; a surgeon in a ship may see 
his patient in less than five minutes after the receipt of the in- 
jury ; and to the surgeons of the navy we must hereafter defer 
for their testimony as to the absence or presence of any con- 
stitutional alarm and shock ; and if they occur, to what degree 
do they follow immediately after the receipt of such injury. 
The question must not be encumbered and mystified by a re- 
ference to all sorts of amputations after all sorts of injuries, 
but to the one especial injury — viz., that of the upper half of 
the thigh. 

48. My experience, which may be erroneous, like every thing 
human, has taught me, that when a thigh is torn or nearly torn 
off, by a cannon-shot, there is always more or less loss of blood, 
suddenly discharged, and which soon ceases in death, or in a 
state approaching to syncope. When the great artery is torn, 
this fainting saves life, for an artery of the magnitude of the 
common femoral does not close its canal by retracting and con- 
tracting, as a smaller vessel does ; it can only diminish it ; and 
the formation of an external coagulum is necessary to preserve 
life, which the shock, alarm, and fainting, by taking off the 
force of the circulation, aid in forming ; and without which the 
patient would bleed to death. An amputation, in this state of 
extreme depression, might destroy life. 

49. If the cannon-shot, or other instrument capable of crush- 
ing the upper part of a thigh, should not divide the principal 
artery, and the sufferer should not bleed, it is possible he may 
be in the state alluded to, in which the patient, for he may not, 

1853.] On Amputation. 47 

be called sufferer, is said to be just as composed as if he had 
only lost a portion of his breeches. Nevertheless few have 
seen a man lose even a piece of his breeches by a cannon-shot 
without perceiving that he was indisputably frightened. 

50. Whilst some persons, under the loss of a limb high up, 
are reduced to a state of syncope, or nearly approaching to it, 
which renders them almost, or even entirely speechless ; others 
suffer extreme pain, and earnestly entreat assistance, under 
which circumstances, amputation should be performed forth- 
with. In the former, the administration of stimulants may 
render the operation less immediately dangerous. 

51. Chloroform, or other similar remedies, may produce an 
effect in such cases yet unknown. Its careful administration 
may not destroy the ebbing powers of life, and may render an 
amputation practicable, which could not otherwise be perform- 
ed without the greatest danger. It may be otherwise ; the 
point, however, is to be ascertained, although in all cases of 
great suffering its use should be unhesitatingly adopted. 

52. When the sufferer is brought to the surgeon at the end 
of half an hour, having lost a limb below the thigh or shoulder, 
by a cannon-shot, he will often be found in a state of such great 
depression as to be likely to be destroyed by the infliction of a 
serious and painful operation like amputation. This has oc- 
curred to me so often as to induce me to recommend delay for 
five, six, or even eight hours, if the unfortunate person did not 
sutler much, and appeared likely to be revived by the proper 
use of stimulants. 

53. This recommendation originated from the fact, that as 
one seriously wounded man has as much claim as another to 
the attention of the surgeon, all could not be attended to at the 
same time ; and the success following the deferred cases of 
amputation was as great, if not greater, than in those on which 
the operation was more immediately. performed. 

54. The advantageous results of primary amputations, or 
those done within the first twenty-four, or at most forty-eight 
hours, over secondary amputations, or thdse done at the end of 
several days, or three or four weeks, has been so firmly and 
fully established as to admit no longer of dispute. 

55. When an amputation is deferred to the secondary period, 
a joint is often lost. A leg which might have been cut off be- 
low the knee in the first instance, is frequently obliged to be 
removed above the knee when done in the second. 

56. In the secondary period after £reat injuries, the areolar 
and muscular textures near the part injured are often unhealthy, 
the bones are in many instances inflamed internally, and their 
periosteal membranes deposit on the surrounding parts so much 

48 Preparations of Arsenic. [January, 

new ossific matter as frequently to envelope in a few days the 
ligatures on the vessels, and render them immovable, necrosis 
of the extremity of the bone following as a necessary conse- 
quence, protracting the cure for months. 

57. Sloughing of the stump, accompanied by inflammation 
of the vein or veins leading to the cava, frequently take place. 
This state of stump is often followed by purulent deposits in 
and upon the different viscera, and principally in the cavities of 
the chest. Where febrile diseases are endemic, they often pre- 
vail ; the constitutional irritation is great ; the stumps do not 
unite, or open out is apparently united and slough, and fre- 
quently after a few days implicate the veins. — [London Lancet. 

Preparations of Arsenic. 

Arsenic, the therapeutic use of which appears to have been 
from the earliest ages diffused generally throughout India and 
China, has been, since the sixteenth century, much employed 
by the physicians of Germany, England, France and Italy. 

The therapeutic history of this heroic remedy is one of the 
most interesting on record. Thousands of facts had long at- 
tested the efficacy of arsenical preparations in the treatment of 
intermittent fevers, when experience proved that they might 
be also advantageously employed in diseases of the skin ; it was, 
moreover, known that arsenic had been extolled in India as a 
remedy in the most serious affections, and particularly in ele- 

In 1817, Biett, repeating at the Hospital St. Louis the ex- 
periments he had just witnessed in the London Hospitals, 
introduced into France the employment of arsenic in the treat- 
ment of cutaneous affections, and from the first laid down rules 
for its use, which it has not since been found necessary to 

The preparations of arsenic, notwithstanding their incontesti- 
ble value in the treatment of many diseases of the skin, are not 
applicable to all. They are principally useful in the essential- 
ly chronic affections ; in the dry forms, such as psoriasis and 
lepra ; and in eruptions of another class, which, after having 
resisted rational treatment, and having become, as it were, 
established, show an obstinacy which seems dependent on local, 
idiopathic conditions of the skin, as in chronic-lichen, and espe- 
cially in certain forms of eczema. 

They afford us the most effectual remedies in the treatment 
of the elephantiasis of the Greeks. 

Good effects have also been obtained from the employment 

1853.] Preparations of Arsenic. 49 

of arsenical preparations in the treatment of venereal diseases, 
and especially in the tuberculous and scaly forms of syphilitic 

I have already mentioned that the efficacy of certain decoc- 
tions (de Felz. d' Arnault, &c.) in the composition of which 
more or less antimony is employed, is generally attributed to 
the presence of arsenic. 

Iodide of Arsenic — Thompson's Pills. — Iodide of arsenic, 
three-fourths of a grain ; extract of hemlock, one scruple: make 
into ten pills — one to be taken every eight hours. This very 
active formula has been principally employed in lepra. 

Mr. Donovan has recommended the double iodide of arsenic 
and mercury, a compound of equal parts of iodide of arsenic 
and bin-iodide of mercury, in the treatment of lepra, psoriasis, 
lupus, and of syphilitic affections. Solution of double iodide of 
arsenic and mercury modified by Soubeiron. — Iodide of arsenic, 
iodide of mercury, of each, one part ; distilled water, ninety- 
eight parts. This solution contains an hundredth part of each 

Arsenious Acid. — Liquid Arsenious Acid. — A solution of 
three-quarters of a grain of arsenious acid in eight ounces of 
distilled water is employed under this name in the German hos- 
pitals. The dose is one table-spoonful, gradually increased to 
six, and is to be taken in the morning on an empty stomach 
(Foy.) Dr. Gilbert! } s formula : Arsenious acid, three-quarters 
of a grain; distilled water, sixteen ounces; dissolve by the aid 
of heat ; divide into five phials, the contents of each of which 
are to be taken in the morning of either one or two days, accord- 
ing to circumstances. This formula is generally preferred by 
M. Gilbert in the treatment of diseases of the skin, and especial- 
ly of psoriasis. Asiatic Pills. — Arsenious acid, three-quarters 
of a grain ; black pepper, ten grains ; gum Arabic, one-sixth of 
a grain ; water, as much as sufficient to make twelve pills — one 
to be taken daily. This preparation is very active; it is the 
one I usually prefer, varying the dose from one to two, but 
more frequently diminishing it in the following manner: — 
Take the mass of Asiatic pills, eight grains ; extract of taraxi- 
cum, twenty-three grains ; mix and divide into twenty-three 
pills, of which one or two are to be given daily. 

Arsenite. — But one arsenite is employed in therapeutics, 
namely, the arsenite of potash, forming the basis of Fowler's 
solution, which is a very energetic medicine, and requires to 
be used with caution. Biett, who frequently prescribed it, re- 
commends that the daily dose should at first be only two or 
three drops, and never exceed twelve, administered in two 
equal portions. 

50 Intussusception of the Bowels. [January, 

Arsenical Solution. — Arseniate of 
soda, three-quarters of a grain ; distilled water, one fluid ounce; 
dissolve and Alter (Cordex.) Dose: a scruple, gradually in- 
creased to half a drachm. This preparation is milder and more 
manageable than Fowler's. I prefer it with women and chil- 
dren, in cutaneous diseases. Biett s Arsenical Liquor. — Ar- 
seniate of Ammonia, three grains ; distilled water, four fluid 
ounces. The uses and dose of this are the same as those of 
the preceding preparation. Pills of Arseniate of Soda. — Ar- 
seniate of soda, three-quarters of a grain ; extract of taraxicum, 
half a drachm ; divide into thirty pills — one or two to be taken 
for a dose. Use, the same as of the preceding preparation. I 
often employ thisformule with advantage. Pills of Arseniate 
of Iron (Biett.) — Arseniate of iron, two and a half grains; ex- 
tract of hops, one drachm; syrup orange flower, a sufficient 
quantity ; make into forty-eight pills. Biett employed these 
pills particularly in scaly affections and in lupus — the dose is 
one daily. — [Dublin Quarterly Journal. 

Remedy for Intussusception of the Bowels. By A. S. Baldwin, 

of Jacksonville, Florida. (Extract from a letter to the Edi- 

Having recently seen in the medical periodicals, several re- 
ports of post-mortem examinations, in cases of intussusception 
of the bowels, I am induced to send you an account of a rather 
simple, but what appeared to me a very effectual remedy for 
this complaint, in a case which came under my care about four 
years ago, when I had despaired of affording relief by the ordin- 
ary remedies. If it shall seem to you to have sufficient merit, 
it may, perhaps, by giving it publicity in your journal, induce 
other members of the profession to give it a trial. During the 
last fifteen years, several cases of this complaint have come 
under my observation, most of which terminated fatally. The 
various remedies recommended were applied ; among them the 
long elastic tube, for the purpose of throwing fluids high up 
into the bowels, with the hope of distending them so that the 
vaginated folds of the intestine might be drawn out. In some 
instances, at least, its use appeared to be productive of mischief, 
from passing through the constricted part of the intestines, so 
that the fluid injected was lodged in the pouch or sack existing 
above the point of obstruction ; to ineffectually increase the 
distension already existing there ; for, when the tube was with- 
drawn, no fluid was returned, and the distension was increased 
without having the effect to remove the difficulty. Injections 
administered by the common syringe were returned immedi- 

1853.] Intussusception of the Bowels. 

ately, even while giving them, ana" had no effect to distend the 
lower bowel, so as to aid in overcoming the obstruction, and 
the conclusion arrived at was, that adhesions existed between 
the folds of" the invaginated parts of the bowel, and the obstruc- 
tion was irremediable. 

Circumstances which have occurred to me, dispose me to 
think that these adhesions do not take place so early, or so fre- 
quently, as many are disposed to believe. About three years 
ago, a case of this kind occurred in my practice, and for several 
days all the appliances which had been recommended had been 
used to overcome the obstruction, but without avail. There 
was a circumscribed spot, to the left of the umbiiicus, and a 
little below it, which was painful ; there was considerable dis- 
tension of the abdomen, with a sensation of soreness across, but 
which did not amount to pain (being what is called in this 
country "misery"). Twice in this case the long tube was 
used, and injections thrown high up into the bowels, which, 
however, did not return upon the withdrawal of the tube, but 
added to the swelling previously existing above the point of 
obstruction. I was apprehensive that adhesion had by this 
time taken place, and as I despaired of relief by the ordinary 
methods, and the patient had arranged his temporal affairs 
and given himself up to die, I determined to distend the lower 
bowels, to their utmost capacity, by the injection of warm water. 

An ivory tube, having a shield around it, was introduced and 
passed up until the shield was pressed up against the sphincter 
ani, a cloth was wrapped around this and pressed up firmly ; 
the tube was now connected by an elastic tube with the pump, 
which was placed in a wash-basin of warm water, which was 
slowly injected into the bowels, pressure being kept up to pre- 
vent its return. Another basin of water was brought, half of 
which was thrown up. The abdomen was, of course, much 
distended by this quantity of fluid, and considerable rumbling 
and commotion of the bowels were produced, the pain at the 
point of obstruction was, for a moment, acute, causing the pa- 
tient to cry out. The pressure and tube were removed, and 
we found he had the power to retain the injection until he 
could be helped to the chair, when about five quarts of the in- 
jection was passed ; becoming faint, he was laid upon the bed, 
and brandy and water administered ; he soon rallied, and pass- 
ed as much more, colored by fecal matter ; soon after, a copious 
and regular, but very offensive stool was had, in which the oil, 
taken several days before, could be distinguished. After this, 
he had no farther difficulty, except debility, and a sensation of 
soreness at the point of obstruction, which lasted for a few- 
days, when he returned to his work, that of a carriage-maker, 

52 External use of the Nitrate of Lead. [January, 

and up to the present time Has had no return of the complaint. 
Since that time I have not had so severe a case of this com- 
plaint, but in every case which shows a disposition to be obsti- 
nate, I resort to this mode of injection, with uniform and im- 
mediate success. Perhaps some of these would have been as 
obstinate as the one above detailed, if the former mode of 
treatment had been pursued; but I am fully impressed with 
the belief that, had this remedy been used with those cases 
which had proved fatal, some of them, at least, might have 
been saved. The case in which I first tried it was an unprom- 
ising one, on account of the long time which had elapsed since 
the attack before the remedy was used, sufficient for adhesive 
inflammation to have agglutinated together the folds of intes- 
tine involved in the intussusception. — [Am. Journ. Med. Sc. 

External use of the Nitrate of Lead. 

Dr. Ogier Ward was induced to make use of this prepara- 
tion in cases accompanied by feted discharges, observing its 
advantages as a disinfectant under other circumstances. 

The first case in which he used it with this intention was 
that of a lady, whose lochia were so offensive as to scent the 
whole house, and nauseate even the nurse. It was used as an 
injection ; and the third application effected the complete re- 
moval of the fetor. 

He has also used it with success as a lotion for sore legs 
when in a sloughy and indolent condition, and finds that it soon 
restores them to a healthy state, inducing a proper secretion 
of pus, with firm granulations on the surface of the ulcer. 

He has not used the nitrate in acute gonorrhoea, but states 
that it acts admirably as an astringent in gleety discharges, as 
well as in those of cancer uteri, whether sanious or purulent. 
In short, as a lotion it is as extensively useful as the diacetate 
of lead, while it is superior to that preparation by its disinfect- 
ing property. 

In chronic cutaneous diseases he has seen the most remarka- 
ble instance of its efficacy in a case of eruption, of a kind of 
rupia or impetigo of five years' standing. The complaint broke 
out on the vertex of a woman, set. 50, and, leaving its original 
site, it has gradually crept down over the forehead, nose and 
cheeks, to the level of the mouth. The primary form of the 
eruption consisted of inflamed, flattened pustules, slightly ele- 
vated above the surrounding skin, which, discharging their 
contents, formed thick, rough, yellowish crusts, or scabs, fis- 
sured in all directions, like those of crusta lactea, which, firmly 
adhering and growing from their base, like rupia, for a longer 

1853.] Manganese as an Adjuvant to Iron. 53 

or shorter time, fell off at last, leaving cicatrices of various 
shapes, exactly like the seams and pits of smallpox. The pa- 
tient came under Dr. Ward's care some months ago, when he 
tried many remedies, both internal and external, in vain, quinine 
being the only one that produced any good effect, and this not 
permanently. As the skin around the sores and where they 
had healed seemed in a state of hypertrophy, the papillae pro- 
jecting in many places as in elephantiasis, it occurred to him 
that the best way to check the progress of the disease would 
be to apply some penetrating astringent to the surface; and 
with this view he ordered a lotion of the nitrate of lead, with 
quinine, internally. In the course of a few days, the eruption 
ceased to make any progress, the crusts began to IjlII off, and 
the skin to lose its redness and swelling ; and in a fortnight 
every sore was healed, though the face and forehead remained 
still seamed with scars. There has been no fresh breaking out 
for some weeks, though, as the nose is still red and swelled, he 
has ordered the continuance of the lotion. 

The formula he generally uses is the following : — ty. Plumbi 
carb. scr. j ; Acid. nitr. dil. q..s. ad solvendum ; Aquae dist. fej. 
M. Fiat lotio bis terve indies assidue utenda. — [Prov. Med. 
and Surg. Journal. 

On the use of Manganese as an adjuvant to Iron. By M. 

M. Petrequin quotes various authors to prove that manga- 
nese is a normal constituent of the animal and vegetable tissues; 
and believes that wherever iron is present in appreciable quan- 
tity, manganese co-exists with it. Hence iron alone will not 
always succeed in blood-diseases. M. Petrequin has observed 
many cases of chlorosis, which have resisted iron as obstinately 
as anaemia connected with cancer or organic degeneration. 
Other cases again, after deriving a certain amount of benefit 
from iron, remain stationary. Others again appear cured by 
iron, but the cure is not permanent. The remedy required in 
this case, M. Petrequin finds to be manganese. He does not 
give it or iron alone, but combines them. 

It is especially in diseases of the blood that ferro-manganic 
medicines are useful. They have a special action on the vas- 
cular apparatus, on the formation of the blood, and on the circu- 
lating fluid itself. They do not act as tonics or astringents, 
but as regenerators of the blood. They have succeeded ad- 
mirably in anaemia following haemorrhage, operations, polypi, 
metrorrhagia, etc. ; also, in chlorosis attending puberty, which 

x. s. — VOL. IX. no. i. 4 

54 Manganese as an Adjuvant to Iron. [January, 

is a more common disease than is generally supposed, and oc- 
curs even in males. M. Petrequin has also frequently found 
the combinations of iron of benefit in the diseases of women at 
the critical period. He has often seen in these subjects, metror- 
rhagia, accompanied with an aspect of the surface which 
would lead to the suspicion of organic uterine disease: the 
haemorrhage, however, was but a complication, and the pa- 
tients, apparently in a hopeless state, have recovered under the 
use of ferro-manganic preparations, conjoined with tonics and 

In amenorrhea and dysmenorrhea, the patients often ima- 
gine that they require to be bled ; but care must generally be 
taken not Jo comply with this request. M. Petrequin has more 
than once seen cases of amenorrhcea with severe chlorosis, in 
which it has not been desirable to hasten the appearance of the 
catamenia — the consequent loss of blood aggravating the dis- 
ease. The general state of health must here be attended to. 
(Edema of the lower limbs sometimes occurs in these cases; but 
it is a less severe complication than when it attends metrorrha- 
gia. It often disappears, as the.patient recovers, under the use 
of iron and manganese. 

These medicines are no less efficacious in the treatment of 
ancemia resulting from prolonged intermittent fevers, prolong- 
ed suppuration, strumous, syphilitic, or cancerous affections, 
phthisis, etc. Pills and the syrup of the iodide of manganese 
and iron are preferable in these cases. 

In all these cases, the ferro-manganic preparations do not 
merely act on the stomach and nervous system, but they are 
absorbed, and assist in the formation of haematosine and new 
blood-globules, so as to restore the blood to its normal condi- 
tion. Their effect in this way is greater than that of iron alone. 

In the functional affections of the heart connected with chlo- 
rosis and anaemia, and which must not be mistaken for organic 
disease, a combination of iron and manganese with digitalis 
and other moderators of the heart's action is advantageous. 
The same remark applies to the functional disorders of the 
lungs, attending the same constitutional states. 

Disordered states of the nervous system are intimately con- 
nected with those of the blood. He, as well asM. Gubian,has 
observed that iron is here better tolerated when combined with 
manganese. He has also seen benefit from the use of iron with 
manganese in many cases of dyspepsia, gastralgia, and gastro- 
enteralgia. Nervous affections of the digestive organs are 
often the result of chlorosis ; and, where stomachics and cin- 
chona have failed, iron has often been found (especially the 
carbonate, by some English physicians) to be of service. Gas- 

18. r >3.] Manganese as an Adjuvant to Iron. 55 

trodynia complicating chlorosis has often yielded to the use of 
ferro-manganiferoua water, and to pills of carbonate of iron and 

In nervous affections connected with exhaustion from venere- 
al excesses, onanism, rapid growth, &c, as well as in leucor- 
rhcea, diabetis, &c, M. Petrequin has a high opinion of these 
medicines. He is continuing his researches on their action in 
certain cases of sterility from asthenia, and in some hyposthe- 
nic affections of the scalp, such' as early baldness, alopecia, &c. 

M. Petrequin has confined his observations to a limited num- 
ber of the fm-o-manganic preparations; and has made many 
observations before publishing the formula? which he finds most 
useful. Having found, even at an early period, that the medi- 
cines were liable to adulteration, he has availed himself of the 
assistance of competent pharmaceutists. Since the publication 
of his first memoir, in 1849, these medicines have been exten- 
sively used in the South of France and in foreign countries. 

The formulas are few, and correspond to the prepa'rations of 
generally used in France. They are: 1. Pills of carbon- 
ate of iron and manganese, or iodide ; 2. Lozenges of lactate of 
iron and manganese; 3. Syrups of lactate or of iodide of iron 
and manganese; 4. Ferro-manganic chocolate ; 5. Effervescing 
solution of iron and manganese. 

Jt has been said that manganese not only preserves water, 
but purifies that which has undergone a change (Martin Lau- 
zer). Ferro-manganic waters (of which there are many in 
France and other parts of the continent) can be preserved and 
carried to a distance; — which cannot generally be done with 
simple ferruginous waters. 

M. Petrequin commences by giving the powder of iron and 
manganese, with some vinous drink; he then administers two 
pills daily, one before breakfast and one before dinner, replacing 
them soon by lozenges. The syrups and chocolate complete 
the treatment. He gives the medicines at meal-time. The 
syrup he gives before breakfast, in doses of a tea-spoonful ; and 
he finds it useful to administer directly after it some infusion of 
centaury, or of camomile flowers and orange. 

Large doses are unnecessary and useless; for they are liable 
to produce irritation of the stomach and exhaustion of the ner- 
vous system ; and the reparation of the blood is slow and pro- 
gressive, and cannot, even were it desirable, be effected rapidly. 
Besides, the iron and manganese are not absorbed in any 
greater quantity, if large doses are given. 

Preparations of Manganese and Iron. — M. Burin-Dubuisson, 
ot Lyons, who prepared most of the ferro-manganic combina- 

56 • Manganese as an Adjuvant to Iron. [January, 

tions used by M. Petrequin, has published an interesting 
brochure, in which he gives the necessary details relating to 
the subject. The following formulas are extracted from it. 

Powder for Effervescing Solution of Manganese andiron. — 
Take of coarsely powdered bicarbonate of soda, 20 parts ; tar- 
taric acid, 25 parts ; powdered sugar, 53 parts ; finely pow- 
dered sulphate of iron, 1£ parts: finely powdered sulphate of 
manganese, f parts: mix carefully and keep in well stopped 
bottles. A tea-spoonful is mixed with each glass of wine and 
water drunk during meal-time. 

Pills of Carbonate of Iron and Manganese. — Take of pure 
crystallized sulphate of iron, 75 parts; pure crystallized sulph- 
ate of manganese, 25 parts ; crystallized carbonate of soda, 120 
parts; honey, 60 parts; water, a sufficient quantity. Pills of 
20 centigrammes (3 grains) are made ; they keep easily, with- 
out becoming oxidized, in well-closed vessels. From two to 
four are given daily. 

Ferro-manganic Chocolate. — One part of carbonate of iron 
and manganese is first mixed with four of sugar, antf divided 
into large lozenges; of these, 100 parts (grammes) are mixed 
with 500 of chocolate paste, in the preparation of which 100 
parts of sugar have been left out. This will make 800 lozen- 
ges, each of which contains about three centigrammes (nearly 
half a grain) of carbonate of iron and manganese. The choco- 
late decomposes the hydrated carbonate of manganese and iron 
of the saccharate into hydrated sesquioxide of iron and manga- 
nese ; there is no metallic taste. 

Syrup of Lactate of Iron and Manganese. — Take of lactate 
of iron and manganese, 4 parts ; powdered sugar, 16 parts ; rub 
together, and add of distilled water, 200 parts ; dissolve rapidly, 
and pour into a mattrass over a water bath, containing 384 
parts of broken sugar: filter the solution. This syrup con- 
tains about 15 parts of lactate of iron and 5 of lactate of man- 
ganese in 3,000 parts. One or two spoonfuls are taken daily. 

Lozenges of Lactate of Iron and Manganese are made by 
adding 20 parts of the lactate to 400 of fine sugar, with a suffi- 
cient quantity of water. The mass will make 840 lozenges ; 
of which six or eight are taken daily. 

Syrup of Iodide of Iron and Manganese. — M. Burin Du- 
buisson forms a solution of iodide of iron and manganese, in 
the proportion of one part by weight to two of water : the pro- 
portion of the salts is about three of iodide of iron to one of the 
iodide of manganese. Six parts of these are mixed with 294 of 
simple syrup ; of this, M. Petrequin gives one or two tea- 
spoonfuls daily. 

Pills of Iodide of Iron and Manganese. — Take of the 

1853.] Chloroform in Delirium Tremens. 57 

officinal solution prepared by M. Barin Dubuisson, 15 parts 
(grammes); hone}', 5 parts; some absorbent powder, 9{ parts. 
Divide into 100 pills. The honey and the solution are first 
mixed, and evaporated at first rapidly, then more slowly, to ten 
parts. Then add the powder, and divide the mass into four 
parts, which must be rolled in powder of iron reduced by hy- 
drogen; each of these must then be divided on an iron plate 
into 25 pills, and again rolled in the iron powder. Finally, they 
are covered with a layer of tolu, according to M. Blanchard's 

All these preparations must be made very carefully. M. 
Burin Dubuisson has ascertained that the commercial salts of 
manganese frequently contain copper, and even arsenic ; he 
hence insists on the necessity of calcining the sulphate of man- 
ganese, twice, or more frequently, at a dark red heat, and of 
carefully testing the solution. — [London Journ. of Med. 

On the internal administration of Chloroform in Delirium 
Tremens. By George E. Fexwick, M. D., Lecturer on 
Materia Medica, St. Lawrence School of Medicine, Physi- 
cian to the Montreal Dispensary. 

J. S., aged about 40, labouring under an attack of Delirium 
Tremens, brought on by suddenly stopping all stimulants after 
having led an irregular life for months, came under my care 
on the 16th September, 1852. Present symptoms. — Great 
anxiety expressed in the countenance, fear of impending danger 
frequent sighing, general tremor, delirium when left alone, 
which w 7 as of the quiet muttering kind, as if holding conversa- 
tion with some imaginary person, pulse 110, weak, tongue 
covered with a whitish fur, bowels had been opened slightly 
that morning, appetite capricious, had not slept since the Satur- 
day previous. It was o'clock at night when I first saw my 
patient ; I ordered a full opiate, and as he bad formerly been 
in the habit of chewing opium, I prescribed it in six grain doses, 
to be repeated every second hour until he slept ; two doses only 
were administered, the effect of which was to deprive him of 
consciousness, but he did not sleep, he raved and walked about 
his room the whole night. 

The following day, Friday, he was worse, tremor increased, 
constant muttering, though when spoken to he conversed ration- 
ally on whatever subject was stated. He stated there were 
too little devils playing the dium on his head, and that they 
kept up such a noise he could not sleep. The eye exhibited 
greater wildness and less fear than last night, the pulse was 
the same 110, but fuller and more bounding, bowels not open. 

58 Chloroform in Delirium Tremens. [January, 

I prescribed two blue pills rolled in Croton oil, to be taken 
immediately and at night the following draught : — 
$. Spt. iEth. Sulph. 3ii. 
Chloroform, 3 i. M. 

This draught to be repeated every second hour until sleep 
was induced. Owing to a mistake the patient did not take the 
pills till 8 o'clock, P. M., and half an hour afterwards the 
draught was administered ; the pills operated rather briskly, 
both up and down, an hour after they were taken, and the 
draught was not repeated. 

Saturday, 18th. Found my patient somewhat better, although 
he had had but one draught of the chloroform, still, through the 
night he had dozed once or twice for a few minutes at a time. 
The symptoms not being urgent, I ordered porter to be taken 
during the day and nourishment. Visited my patient at 9 
o'clock, P. M., determining to administer chloroform myself 
and watch its effects. 

Igave three teaspoonsful of a mixture composed of chloroform 
and spirits of sulphuric ether, in the same proportions as above ; 
in a few minutes he complained of drowsiness; he closed his 
eyes and became perfectly tranquil, the respirations became 
deeper and slower, the pulse fell from 96 to 62 ; to keep up the 
action I held the bottle to his nose for a few minutes ; I watched 
him for half an hour, during which time he appeared to be in 
a natural sleep. This state lasted for about three hours. At 
leaving, I directed the draught to be repeated in two hours if 
necessary, but my instructions were not attended to. 

The day following, Sunday, he appeared much refreshed, 
less tremor, pulse 72, had eaten a hearty breakfast. I did not 
repeat the chloroform through the day ; that afternoon he slept 
for an hour and a-half ; at night I again visited my patient, and 
again administered the chloroform and ether as before ; a single 
dose threw him into a profound sleep, from which he did not 
awake till six o'clock the following morning. From this time 
he gradually recovered, slept naturally and well without the use 
of chloroform ; the only unpleasant symptom noticed was head- 
ache, which came on for two or three mornings afterwards, 
and lasted for some hours ; this appeared to be relieved by 

The second case which fell under my observation was one 
of quite a different character : — 

Mr. S., labouring under an attack of delirium tremens, 
brought on by a debauch, came under my care 2nd October, 
1852. When I saw him there was considerable anxiety, great 
tremor, the eye wild and staring, features bloated and swollen, 
pulse 120, full and bounding, tongue furred, bowels constipated 

5853.] Chloroform in Delirium Tremens. 59 

liad not slept for two nights ; I administered 2 drops of Croton 
oil immediately, and prescribed the following mixture :— 
$. Tr. Opii 3 ii. 

Ant. Tut. Tart. gr. iv. 
Aquas 5 iv. M. 

Dose, a tablespoonfull to be taken every three hours. The 
Croton oil operated five or six times, and alter the first dose the 
antimony was borne by the stomach. 

This treatment was continued up to the evening of the 4th 
when, as there was bo improvement nor tendency to sleep, I 
determined to employ chloroform, and accordingly prescribed 
the following : — 

R. Spt. iEth. Sulph. 

Chloroform, aa 5 } M. 

Dose, a desert spoonful to be taken every two hours until 
sleep is induced. After the second dose my patient fell into a 
quiet slumber which lasted six hours. The following day, the 
5th, he was much better, countenance improved, eye less start- 
ing, much less tremor, pulse 88, bowels had been moved that 
morning. I ordered the chloroform to be repeated at night. 
After the first dose he slept, and did not awaken till the follow- 
ing morning, when he felt much refreshed, and quite himself; 
he got up, dressed and took a short walk ; being fatigued, on 
his return he laid down again and fell into a sound sleep which 
lasted three hours. I ordered the chloroform to be repeated if 
necessary at night ; however he slept all night without it ; from 
this date he recovered rapidly. 

Chloroform has frequently been enployed in the form of 
inhalation, with advantage, by Dr. Todd and others. In the 
American Journal of Medical Science for January, 185*2, Dr. 
Pratt of Baltimore, published two cases of delirium tremens, in 
which the internal administration of Chloroform was attended 
with most marked success. Since preparing this paper I have 
read another case of delirium tremens published by Mr. Butcher 
in the Dublin Medical Press, in which the internal use of chloro- 
form was attended with like success. Mr. Butcher draws 
attention to the lowering of the pulse when the perfect effect of 
the medicine was produced. This was most marked in the first 
of the above cases, the pulse fell from 96 to 62, it never rose 
above 76 while the patient was under treatment. In the second 
case, I had not an opportunity of observing the immediate effect 
of the medicine on the heart's action, but the pulse fell from 
112, which was the number of pulsations previous to the exhi- 
bition of the chloroform to 88, which was its standard the follow- 
ing morning. 

The foregoing cases, though by no means severe or alarming 

60 Quinine in Typhoid Fever. [January, 

in their character, yet serve as further evidence of the success- 
ful employment of chloroform internally in the above class of 
diseases. In the first case opium had a decidedly injurious 
effect ; all the symptoms were aggravated ; at first I felt at a loss 
how to act : having read Dr. Pratt's cases, I determined to adopt 
the same line of treatment. Another point I would draw atten- 
tion to : in the one case, the disease was brought on by want 
of an accustomed stimulus — in the other, the attack followed 
excess of the stimulus — in both the symptoms were peculiar, 
and in both the result of the treatment satisfactory. 

[Canada Med. Journal. 

[The use of quinine in Typhoid fever has many advocates 
in the United States, but there are also many who regard it as 
not only inefficient but positively injurious. Hence the sug- 
gestion has been made, that when it has proved beneficial the 
cases were not genuine typhoid fever. We therefore lay be- 
fore our readers the following article, as the cases referred to 
occurred in a country in which malarial fevers are as rare as 
those termed typhoid are common.] 

Remarks on the Treatment of Typhoid Fever by Disulphate of 
Quina. By J. W. Hayward, Esq., Liverpool. 

In a practice, private and parochial, of which I have had 
charge for some time, at the south end of this town, I made 
particular observations on eighty successive cases of fever of 
the typhoid type ; and I found the first symptom, in twenty of 
them, was diarrhoea; in twelve, diarrhoea and vomiting; in se- 
ven, vomiting alone ; the rest began with pain in the head. All 
had pain in the head afterwards ; sixty-six describing it as 
" lightness," fourteen as " heaviness." All had tenderness of 
abdomen — nine to a great extent. Seventy-one complained 
of soreness of the flesh over the whole body — some to such 
an extent that their impression was that they had rheumatism. 
Seventeen had considerable inflammation of the sub-maxillary 
glands. Seventy-three had delirium, twenty-one of which 
were very severe. In all, the tongue became very dry, brown, 
hard, and cracked; the first crack was generally a deep, longi- 
tudinal one down the centre of the tongue, (even whilst it was 
clammy and velvety in appearance, and of a milk-and-water 
colour,) extending from the base to nearly the apex ; then ma- 
ny transverse and oblique ones. In twenty-four, the skin be- 
came rough and brown, with petechia? observable. In all, the 
thirst was intense ; and the other symptoms of fever were not 

1853.] Quinine in Ti/]> It oid Fever. fll 

less evident; therefore suffice it to say they were well-marked 
cases of fever of the typhoid character. 

In twenty-seven the treatment was commenced in the "first 
stage ;" in fifty-three in the "second stage." Three were fatal. 
All the rest recovered more or less quickly. 

The principal treatment in all except one was the use of di- 
sulphate of quina, — so much recommended by Dr. Dundas, of 
this town, — of course modified according to the predominating 
symptoms. Thus, if I found the pulse quick, weak and thready; 
the tongue cracked, brown, and dry, (rough or smooth ;) great 
thirst and delirium ; no appetite ; tenderness of abdomen ; sore- 
ness of flesh, &c, I put the patient upon disulphate of quina, 
in solution, at once ; four or five grains every two hours. If 
great restlessness, and no sleep, I added three or four minims 
of tincture of opium to each dose. If* general sinking of vital 
powers, some wine or brandy, with beef-tea. If the solution 
of quina were vomited, it was given in an equal quantity of 
wine, or wine-and-water. If the patient continued sinking, 
I increased the quantity of quina, but never had occasion to 
extend beyond seven grains per dose. When ringing in the 
ears occurred, the quantity was decreased, but still kept up till 
there was a good appetite. If the delirium was intense, the 
pain in the head described as heavy, (which were always 
strong subjects, whose bowels were confined,) with strong 
pulse, a dose of chloride of mercury, and sometimes a blister to 
the nape of the neck. If tenderness of abdomen was great, a 
few leeches or sinapism. If vomiting, a sinapism over the- 
stomach. If diarrhoea, a little calomel and opium, or diacetate 
of lead and opium ; though this symptom sometimes required 
nothing more than the tincture of opium given with the quinine. 

In seventy-nine cases, marked improvement was observable 
in the course of twelve hours : the pulse was the first to improve, 
then the delirium to give way, then the pain in the head, the 
thirst, the soreness of flesh, tenderness of abdomen, dryness of 
tongue, and the appetite to improve. A pulse of 120, small and 
thready, would become 90, softer and fuller ; and in the majority 
of the cases the pain in the head and delirium ceased entirely 
in the same period, and a rapid improvement followed ; with 
the small exception of two cases of children ten and eleven 
months old, neither of whom had the medicine regularly, and 
both were complicated with bronchitis. The eightieth case 
was that of a woman, in which quina was not used. These 
three died, evidently from typhus. If the typhoid symptoms 
were allowed to become well marked, and the patient to sink 
much, his recovery was slow 7 , and he required wine or brandy. 
I feel confident, from personal observation, that were the disul- 

62 Loose Bodies in Knee-joint. [January, 

phate of quina to be used promptly, and to cinchonism, the 
mortality even of typhus itself would be very small. 

P. S. — The practice alluded to is that of Dr. Whittle, who 
wishes me to make this communication to you. — Lond. Lancet. 

Method of fixing Loose Bodies in the Knee- Joint. By Dr. E. 

All surgical writers agree upon the necessity and difficulty 
of properly securing loose bodies in the knee-joint, for the pur- 
pose of removing them. The following method is proposed, 
as one on which we can rely : Having placed the loose body 
at the upper part of the synovial cavity, to the right or left of 
the tendons of the rectus and vasti muscles, let an assistant 
firmly grasp the lower end of the femur with both hands, 
having one thumb on the right and the other on the left side of 
the foreign body, with their extremities in contact below it : 
thus confining it in a triangular space, two sides of which are 
formed by the thumbs, the other and upper one being bounded 
by the capsular ligament. This arrangement, with due pres- 
sure, secures it effectually, and without difficulty, gives the 
operator the use of both his hands, allows the incision to be 
made in the direction of the limb, and prevents the escape of 
synovia, and the admission of air or blood to the joint. 

[Boston Med. and Sur. Journal. 

am t s 1 1 1 1 a n £ . 

Our Journal. — In issuing the first number of another volume of the 
Southern Medical and Surgical Journal, we take oocasion to return 
our thanks to the numerous contributors who have made it the medium 
of their communications to the profession, and who have thus added 
to its usefulness as well as reputation. Thirty-two writers, residing 
in nine different States, viz., Alabama, Florida, Georgia, Louisiana, 
Massachusetts, Mississippi, South Carolina, Tennessee and Virginia, 
have furnished us fifty-two original articles for the last volume, which 
will, we think, compare favorably with the original department of any 
of our contemporaries. The great majority of these papers are essen- 
tially practical, very few of them being theoretical disquisitions. This 
we regard as an important feature in this publication, and have 
always borne it in mind in making up the Eclectic department. 
Among our selections, we count sixty-six original American articles, 
derived from our respected exchanges, thus making no less than one 

1853.] Miscellany. 01 

hundred and eighteen contributions to medical knowledge by our own 
countrymen, in the volume for 1852 ! We are not of those who will 
transfer to their columns every idle lucubration or hasty suggestion 
found in foreign prints, while they pass without notice the writings, 
however valuable, of their fellow-citizens. Thifl indifference, mani- 
fested by some of our contemporaries, to the dissemination of Ameri- 
can contributions, has been long felt and complained of by the profes- 
sion — and while we know that we have not republished as many of 
them as we would have wished, we have the satisfaction to reflect 
that we have done as much as our limits would permit. There are 
Abstracts, Retrospects, and Periscopes published in Europe, repub- 
lished in the United States, and bought extensively by our professional 
brethren, and which yet scarcely contain an allusion to anything done 
or written in this country. Why so? Can it be that nothing is done 
or written by the American medical profession worthy of a place in 
such compilations ? 

Dr. Norwood, and others, have now for two years been publishing 
from time to time, in this Journal, the discovery and usefulness of an 
agent capable of controlling with almost mathematical certainty the 
action of the heart in disease. There are upwards of thirty medical 
periodicals published in the United States, with all of which, save one, 
we exchange. Of these, we doubt whether more than five or six 
have ever noticed the discovery directly or indirectly. How difFerent 
would the case have been if the newly ascertained property of Vera- 
trum Viride had been first announced in England, in France, or even 
in the depths of Germany! We might cite similar instances of disre- 
gard of valuable contributions published in the Journals of almost 
every section of our country. They are therefore not peculiar to 
this nor to any other of our native periodicals. 

The rapidly increasing patronage extended to this Journal, gives us 
the gratifying assurance that our course meets the approbation of the 
profession, and no efforts will be spared to retain this. 

We take pleasure in calling the attention of our readers to the 
valuable articles in this number, from the pen of Drs. Jackson and 
Norwood — both upon subjeefs of great interest, and by writers exten- 
sively known. We regard it quite an honor to be favored with the 
contributions of the great discoverers of the anesthetic property of 
Sulphuric Ether, and of the heart-subduing influence of Veratrum 

64 Miscellany. [January, 

Case of Abstinence for three months, no Food, during that period, 
being taken into the Stomach. By J. L. Pierce, M. D., of Fallsington, 
Bucks county, Pennsylvania. — On the 13th of January, 1836, my 
friend, Dr. May, was about leaving Philadelphia for the East, and 
requested me to take charge of a number of cases of considerable inter- 
est, which he then had under his care. Among these was a lady, 
who had for many months been severely affected with disease of the 
stomach. As the exact character of the disease may admit of dispute, 
and as it is not this to which I wish to draw attention, but a peculiari- 
ty in the mode of treating it, I have headed the article in the manner 
it stands. 

I called, with Dr. May, to see this patient on the 13th of January, 
1836. She was about 26 years of age, sallow complexion, emacia- 
ted, pulse 120, feeble, but regular. A spot over the left epigastric 
region, of an inch and a half in diameter, was very tender on pres- 
sure, and considerable tenderness existed for some distance around it. 
Her appetite, though not craving, was sufficiently good to enable her 
to eat almost any food, though she had been restricted to a very sim- 
ple diet. Her bowels were open every two or three days, passages 
natural. She was in the habit of vomiting several times a day, and 
her food was generally rejected within a few minutes after it was ta- 
ken. She had been sick about three months, and had been confined 
to the bed a large portion of this time. 

I was informed that her case had been considered as carcinoma of 
the stomach. Her treatment had consisted of such articles as were 
calculated to allay the irritabilty of the stomach and the vomiting, and 
to quiet the severe pains of the epigastric region. A constant sore 
had been kept up over the affected spot by means of blisters, which 
were dressed with anodyne ointments, and occasionally leeches were 
applied to the spot. 

On taking charge of the case, I watched it for some days very close- 
ly. I found that neither food nor medicine appeared to remain upon 
the stomach, but that as often as either was administered, vomiting 
ensued ; and with the food ejected, there was from a tea-spoonful to a 
table-spoonful of matter, such as is usually discharged from an ab- 
scess. Should nothing be taken into the stomach for some hours, 
emesis would take place of this kind of substance by itself. During 
the first week, I pursued the same mode of treatment as had been 
made use of formerly, but I soon became satisfied that it was alto- 
gether useless, and that the patient must sink unless some more 
.effectual plan were adopted. The simplest medicine taken into the 
stomach was rejected as soon as the severer kind, and even gum 
Arabic water or barley water was as irritating as oysters or roa6t beef 
could have been. 

Towards the close of January, I asked her if she was willing to 
submit for one month to an entire abstinence of all kinds of food by 
the mouth, and be nourished solely by enemata. The idea was a 
novel one to myself, but my view was that the stomach must rest, and 
Jet the character of the disease be what it might, it would thereby 

1853.] Miscellany. 65 

stand a much better chance of healing. That there was a suppur- 
ating sore in the stomach appeared evident, and rest was absolutely 
essential. She was now exceedingly emaciated, and so feeble that 
she was entirely confined to the recumbent posture. 

On the 1st day of February we entered upon our new mode of 
treatment 1 directed lamb or mutton broth of good quality to be kept 
constantly on hand, and a half a pint to be used as an enema every 
three hours. During the first week, 1 allowed her to take notexce 
inga tea-spoonful at a time of gum Arabic water or pun ev- 

eral times a day, with the request that she would lessen the frequency 
of it towards the latter part of the week, so as to be able to refrain 
from it entirely on the commencement of the second week. She very 
readily acceded to my wishes in every respect, and I have not the 
least doubt ot her acting with perfect honesty towards me. I kept up 
a running sore over the epigastric region, which I dressed with simple 
cerate or basilicon ointment, sprinkled with morphia. 

During the first week my patient vomited from three to six times 
daily, discharging pus, and a considerable quantity of matter resemb- 
ling tubercles. Her sensation of hunger was at times great, but she 
bore it with remarkable fortitude. At the expiration of the week she 
was evidently more comfortable, and became increasingly so during 
each succeeding week of the month, at the close of which her condi- 
tion was as follows : Vomiting occurs on an average about twice a 
day : substance discharged the same as before, tinged with a little 
blood ; tongue clean ; pulse fuller than formerly, and less frequent ; 
countenance more healthy. I now asked her if she were willing to 
continue the same treatment for another month. She did not hesitate 
in giving a prompt response ; and, during this month, not a drop or 
morsel of any thing passed her lips. 

April 1. Condition in every way improved. The vomiting occurs 
once in two or three days ; quantity less ; appearance of discharge 
white, with but very few of those particles resembling tubercles; 
bowels regular ; pulse 90 ; very little pain ; strength improving. 

I now requested her to continue the treatment one month longer. 
She consented to do so, and it was astonishing how rapidly the im- 
provement progressed. By the middle of the month I consider the 
cure to have been nearly completed, but thought it best not to depart 
from the course we had been pursuing, lest irritation of the stomach 
should renew the vomiting, and other unpleasant symptoms. About 
the 24th of the month, 1 allowed her a tea-spoonful of gum Arabic 
water three or four times a day, with directions to increase it in fre- 
quency each successive day. so that the stomach might be gradually 
prepared for its usual nourishment. By the close of the month I felt 
satisfied that the disease of the stomach had cealed, that the sore had 
healed, and that my patient, by a forbearance and perseverance 
seldom equalled, had been rescued from an untimely irrave. She w 
now able to sit up a considerable portion of the day, a part of the 
time attended to some needle work or knitting ; could walk some dis- 
tance without assistance ; complexion good ; pulse 80; bowels regular 
and much fleshier than when 1 commenced my attendance upon her. 

66 Miscellany. [January, 

I continued calling on the patient occasionally until the 18th of 
May, when I took my leave of her, with many blessings showered 
upon my head. 

In consequence of her removal to Southwark, I lost sight of this 
patient for nearly two years, when I accidentally met her in the street. 
Her appearance had so much improved that I searcely recognized her, 
and she assured me that she was in the enjoyment of uninterrupted 
health. — [Am. Journ. Med. Science. 

Binocular Microscope. (From the Transactions of the Phys. Med. 
Society of New Orleans.) — At a meeting of the Physico-Medical So- 
ciety, on Saturday evening, 2d October, Prof. J. L. Riddell called the 
attention of the Society to an instrument of his own invention and 
manufacture, which promises to be of incalculable advantage in 
microscopic researches, especially in the prosecution of microscopic 
anatomy and physiology. 

He remarked, that he last year contrived, and had lately construct- 
ed and used, a combination of glass prisms, to render both eyes ser- 
viceable in microscopic observation. The plan is essentially as 
•follows : 

Behind the objective, and as near thereto as practicable, the light 
is equally divided, and bent at right angles and made to travel in op- 
posite directions, by means of two rectangular prisms, which are in 
contact by their edges, that are somewhat ground away. The 
reflected rays are received at a proper distance for binocular vision 
upon two other rectangular prisms, and again bent at right angles, 
being thus either completely inverted, for an inverted microscope, or 
restored to their original direction. These outer prisms may be 
cemented to the inner, by means of Canada balsam ; or left free to 
admit of adjustment to suit different observers. Prisms of other form, 
with due arrangement, may be substituted. 

This method proves, according to Prof. RiddelPs testimony, equally 
applicable to every grade of good lenses, from Spencer's best sixteenth 
to a common three inch magnifier, with or without oculars or erecting 
eye-pieces, and with great enhancement of penetrating and defining 
power. It gives the observer perfectly correct views in length, 
breadth, and depth, whatever power he may employ ; objects are seen 
holding their true relative positions, and wearing their real shapes. 
In looking at solid bodies, however, depressions sometimes appear as 
elevations, and vice versa, forming a curious illusion ; for instance, a 
metal spherule may appear like a glass ball silvered on the under side, 
and the margin of a wafer may seem to ascend from the wafer into 
the air. 

With this instrument the microscopic dissecting knife can be 
exactly guided. The watch-maker and artist can work under the 
binocular eyeglass with certainty and satisfaction. In looking at 
microscopic animal tissues, the single eye may perhaps behold a con- 
fused amorphous, or nebulous mass, which the pair of eyes instantly 
shape into delicate superimposed membranes, with intervening spaces, 

1853.] Miscellany. (J7 

the thickness of which can be correctly estimated. Blood corpuscli s, 
usually Been as flat disks, loom out as oblate spheroids. Prof. R. 
asserted, in short, that the whole microscopic world could thus be ex- 
hibited in a new light, acquiring a ten-fold greater interest, displaying 
in every phase a perfection of beauty and symmetry indescribable. 
[New Orleans Med. and Surg. Journal. 

Experimental investigations on the antidotal and revivifying proper- 
ties of Nitrous Oxide. — Under this caption the Boston Medical and 
Surgical Journal contains the interesting researches of Dr. George 
J. Ziegler, who deduces from them the following conclusions : 

Firstly, That nitrous oxide or protoxide of nitrogen is a powerful 
and direct arterial, nervous and cerebral stimulant. 

Secondly, That it exerts a direct chemical influence on the blood, 
by supplying the essential elements for thearterialization of that fluid, 
and to a certain extent by inducing that process, thus producing in it 
similar changes to those effected by the atmospheric air, as proved 
by the effect on, and character of the reestablished respiration. 

Thirdly, That it is in these various modes antidotal to the effects 
of certain narcotizing agents. 

Fourthly, That where vital excitability is not completely destroyed, 
this remedy has the power of sustaining and increasing it rapidly, 
and sufficiently to preserve life in numerous instances in which it 
would otherwise be destroyed. 

Fifthly, That it will reestablish life action even after all the usual 
evidences of its existence have failed, such as innervation, respiration 
and circulation ; provided, firstly, that the muscular contractility, or 
vis insita of the heart and other tissues is not lost ; secondly, that the 
blood has not coagulated or deteriorated to such an extent as to be in- 
susceptible of arterialization and revivification ; thirdly, that there is 
no organic lesion of any vital part sufficient of itself to prevent recove- 
ry ; and fourthly, that innervation is still susceptible of reexcitation. 

In conclusion, T will state that in my last paper on the therapeutic 
applications of this agent in the form of surcharged liquid more es- 
pecially, I inadvertently omitted to mention a peculiarity in its phy- 
siological action, which, however, might be anticipated from its influ- 
ence over the contiguous renal apparatus, viz., its stimulant effect on 
the generative organs, thus operating as an aphrodisiac. This effect, 
like its diuretic, is not, however, constant or universal ; yet, never- 
theless, its application may prove useful in atonic states of this appa- 
ratus. With respect to its favorable therapeutic influences and ap- 
plications, therein detailed, I have no reason to change my views, 
further experience and reflection only confirming still more strongly 
all former observations and impressions. 

Preservation of Camphor. — The difficulty of preserving camphor 
in a state of powder is well known , and is especially experienced by 
those practicing in the country, who carry their own medicines with 

68 Miscellany. 

them. Dr. Dubois, of New Utrecht, informs us that it can be kept 
without change in this condition, by rubbing together in the state of 
powder two parts of camphor, one part of rhubarb, and one part of 
ginger, the articles thus combined' with the camphor not in the least 
interfering with its therapeutic effects. — [New York Med, Times. 

Prize Essays of the American Medical Association. — At a meeting 
of the Association, held at Richmond, Va., May, 1852, the under- 
signed were appointed a committee, to receive voluntary communi- 
cations on medical subjects, and to award two prizes, of 8100 each, 
to the authors of the best two essays. 

Each communication must be accompanied by a sealed packet, con- 
taining the name of the author, which will be opened only in the case 
of the successful competitors Unsuccessful communications will be 
returned on application, after the 1st of June, 1853. 

Communications must be addressed (post paid) to the Chairman of 
the Committee, Dr. Joseph M. Smith, 56 Bleeker-street, New York, 
on or before the 27th of March, 1853. 

Joseph M. Smith, M. D. 
John A. Swett, M. D. 
W. Parker, M. D. 
Gurdon Buck, M. D. 
New York, Sept. 14th, 1852. Alfred C. Post, M. D. 

Epidemics of South Carolina, Florida, Georgia, and Alabama. — 
The undersigned, Chairman of the Committee of the American Medi- 
cal Association on the epidemics of South Carolina, Florida, Georgia, 
and Alabama, vice Dr. W. M. Boling, resigned, respectfully solicits 
from the physicians of those States accounts of epidemics of all dis- 
eases that have been observed by them during the year 1852. 

In the description of each epidemic, attention is earnestly directed 
to the following points: 

1st. The origin and progress, together with its phases, if they pre- 
sent any peculiarities. 

2d. The cause, either certain or probable. 

3d. Its contagious character, or otherwise, with proofs thereof. 

4th. The prognosis. 

5th. The treatment. 

6th. Collateral circumstances, such as meteorological and other 
phenomena, having a direct or indirect bearing upon it. 

The physicians of Georgia who may be disposed to furnish the 
committee with accounts of epidemics, will be pleased to address their 
communications to Dr. S. N. Harris, of Savannah, one of the com- 
mittee. From those of South Carolina, Florida and Alabama, the 
undersigned will gladly receive contributions. 

Charleston, Nov. 1st, 1852. D. J. CAIN, Chairman. 

Correction. — On page 726, in our last No., in the caption of Dr. 
Wellborn's article, read Newnan, Coweta County, Ga., instead 
of "Newton County, Ga." 



Vol. 9.] NEW SERIES.— FEBRUARY, 1851, [No. 2. 


(D r i g i n a I Communications. 


On Spinal Irritation. By P. C. Winn, M. D., of Eufaula, Ala. 

The obscurity under which the physiological endowments 
and actions of the spi?wl system have been veiled, has natural- 
ly resulted in much error as to its pathological conditions, 
symptoms and effects ; for, unless the healthy functions of an 
organ are understood, it is impossible to reach a correct con- 
clusion respecting its pathological state. 

The spinal system constitutes the great nervous highway of 
the animal organism, and yet but little, we believe, was written 
upon, and less known, of spinal disease, until within the last half 
centurv : and although the researches and investigations of Sir 
Charles Bell, Dr. Marshall Hall, Magendie, and others, have 
thrown great light upon the anatomical structure and distri- 
bution of this system of nerves and upon its pathological 
conditions, causing it to be more thoroughly studied and con- 
sequently better understood than formerly ; yet much, indeed, 
remains to be learned — a vast field is here open, inviting the 
earnest inquirer after tiuth to * seek that he may find." 

There exists such a reciprocity of action, especially in dis- 
ease, between the spinal cord, its nerves, and the parts to which 
they are distributed, that the practitioner often finds himself 
lost, or led widely into error, in forming a diagnosis, when the 
spinal marrow and its nerves are the seat of disease. 

The influence of this system of nerves is so universal and so 

x. s. — VOL. IX. no. it. '-3 

70 Winn, on Spinal Irritation. [February, 

diversified, and that principle called sympathy, which is nothing 
more than the extension of a disease, or of the symptoms of 
disease, is here so extensive, and so little understood, that the 
physician encounters great difficulty in making a satisfactory 
diagnosis, and especially is there great difficulty in assigning 
to disease its true location when there exists no other evidence 
of inflammatory action except that of pain ; for we frequently 
meet with disease of some of the viscera, and of other textures 
of the body, while the pain or disease is referred to the back, 
the spinal marrow, the head, while the converse of this is also 

But we design speaking of Spinal Irritation as a special dis- 
ease—a disease sui generis. It is not easy to define clearly what 
the disease consists in — whether it be an inflammation, increas- 
ed excitability, an atony of the nerve, etc. And perhaps it will 
be as difficult to determine, with positive certainty, whether 
the disease is located in the substance of the spinal cord, the 
nerve leading from it, or in the investing membrane. 

The term Spinal Irritation is one of such extensive applica^ 
tion, and, too often, so vaguely used, that we must evidently 
encounter some difficulty in restricting it to its proper limits, 
and in applying it to that condition of the spinal cord which 
we intend to designate as Spinal Irritation. And in adopting 
the opinion which we do, we are conscious that it will conflict 
with the doctrine of some whose opinions are entitled to the 
highest regard. We hope, however, that this article will not 
be thought to savor of vanity, for the writer makes no preten- 
sions to originality. 

We are of opinion that the term strictly applies to an inflam- 
matory condition of the spinal cord or the nerve given off from 
it, just at its exit from the vertebral canal, which is nothing 
more nor less than a myelitis or neuritis, and which may exist 
in any of its stages, from simple congestion up to acute inflam- 
mation or ramollissement. We do not propose considering it 
in its acute form, where the symptoms are clearly and distinct- 
ly developed, but in the latent form, where the symptoms are 
obscured and masked. 

We are of opinion that the disease most generally consists of 
simple congestion ; or, when of long standing, of chronic in- 

1853.] Winn, on Spinal Irritation. 71 

flammation of the cord, the nerves leading from it, or of their 
immediate investing membrane. We come to this conclusion — 
namely, that it is a congestion or inflammation of the cord or 
its nerves — from a consideration of the physiological functions 
of these organs, together with the symptoms developed in the 
disease and the remedies most efficient in arresting and curing 
it. Now we are all aware that muscular action is dependent 
upon the spinal cord and its nerves, and also that the sense of 
feeling depends upon those in connection with the brain — in 
other words, that to produce the sense of feeling in the ex- 
tremities, it requires, for instance, that the nerves, spinal cord 
and brain be intact, which state of things must also exist to 
msure voluntary motion. In the disease under consideration 
these functions are usually altered, increased, diminished, or 
perverted. For instance, if pressure be made over an irritated 
or irritable portion of the spinal cord, it may produce spasm of 
one or more muscles, cough, difficulty of breathing, nausea, 
pain, frequently very acute, in some remote part of the body, 
but always in a part supplied with nerves coming from that 
portion of the cord manifesting disease. And in this opinion 
we must beg leave to differ with some writers, among whom is 
Dr. Wood, of this country. He remarks, in treating of this 
disease, vol. ii., p. 738, that "the most rational view of the 
affection seems to be, that it is seated essentially in the liga- 
ments of the vertebrae, and is generally of a rheumatic or gouty 
character." But it appears to us that this view of the subject 
would not give a satisfactory reason for many of the anomalous 
symptoms attending the disease — on the contrary, we have 
little doubt but that many of the pains thought to be gouty and 
rheumatic, and treated as such, are nothing more than symp- 
toms of spinal disease. 

Among the many articles written upon, or having relation to, 
Spinal Irritation, we notice one by Prof. Ford, (vol. i. ? p. 166, 
Southern Med. and Surg. Journal 1837,) on Remittent fever, 
which throws great light upon the subject now under consid- 
eration, and which bears the marks of earnest, ardent toil after 
truth, and which, too, has already accomplished much in 
making intelligent and modifying the treatment of remittent 
and intermittent fever — the great disease of the South. 

72 Winn, on Spinal Irritation. [February, 

In the article referred to, we find the opinions which we 
candidly adept. In it may be found ample proof that the pain 
felt under pressure is not referable to the skin, the bone itself, or 
the ligaments, as some contend, but to the cord, its nerves and 
their membrane. From the remarks of J. B. Todd, on this sub- 
ject, we infer that he, though less explicit than Prof. Ford, is 
of the same opinion. He says, " When not only pressure from 
without, but even the slightest motion, aggravates the pain, we 
are then forced to admit that the origin of the evil is in the 
vicinity of the spinal cord." And we conclude from these mani- 
festations under pressure and percussion, such as pain, cough, 
dyspnoea, &c, that the disease is wholly dependent upon some 
morbid condition of the cord itself, or of the nerves given off 
by it, and not in the meninges or neurilemma. For, we cannot 
conceive how those remote symptoms could be developed 
were the membranes alone the seat of disease, though there 
might be pain and tenderness at some point in the vertebras; 
nevertheless, we would not deny but that the membranes may 
be diseased at the same time with the cord or the nerves, and, 
in fact, we think it highly probable, from the vascularity of 
these membranes, that the disease may be primarily developed 
in them ; yet, certainly, the thousand remote and anomalous 
symptoms cannot show themselves until the nervous tissue is 
itself involved. We must, however, confess that pathological 
anatomy has done but little to sustain the doctrine here assum- 
ed ; and yet there need be no surprise at this, when we take 
into consideration the anatomical structure of the vascular sys- 
tem of this part — that is, the great number of veins and venous 
radicles, their free and numerous anastomoses with the superfi- 
cial and muscular veins, as well as the absence of valves in 

The author last quoted infers from the above facts, that a 
congestion sufficient to produce the symptoms may easily oc- 
cur, and that congestion be easily dissipated. He contends 
that " the very sections which are made to reach the supposed 
seat of the disease are sufficient to dissipate the venous conges- 
tion." This much we have stated to show that anatomy affords 
some support to the doctrine of Spinal Irritation. 

To give i*7i extenso all the symptoms of this disease, in a 

1853.] Winn, on Spinal Irritation. 73 

dissertation of this character, would lead us too far; for, 
in performing such a task we should have to enumerate the 
entire catalogue of diseases to which humanity is liable, as 
there is scarcely a disease which may not be simulated or mask- 
ed by the one subjudice. The most prominent and, we might 
perhaps say, pathognomonic symptom, is that of pain or tender- 
ness under pressure, percussion, or the application of a sponge 
filled with hot water. This pain is excited by motion, lifting 
or carrying heavy burdens, such as throw much exertion upon 
the spinal column. Frequently the patient is not conscious of 
any irritation or disease of the spinal marrow until detected by 
the physician: he may complain of some uneasiness, aching or 
vague sense of pain along the spine, but often the symptoms 
show themselves in some remote organ or structure. The 
symptoms may be those of pain, formication, numbness, spasm, 
paralysis, dyspnoea, dysphagia, palpitation of the heart, pyro- 
sis, colic, many symptoms referred to the uterus, &c, nearly 
or quite all of which may be increased by pressure, or percus- 
sion over the affected region of the spine. The dreased point 
of the spinal marrow and the complaining organ will be found 
exactly to correspond — that is, the part to which the disease 
is referred being supplied with nerves directly from the affected 
point of the spine. Usually the tongue is clean, but may some- 
times be coated with a whitish fur ; appetite variable, usually 
however there is slight anorexia ; pulse natural, or a little accel- 
erated and weak, seldom or never increased in volume or 
frequency, unless there be inflammatory action elsewhere ; 
irritable temper and melancholy are frequent attendants upon 
this disease. 

The diagnosis is difficult, and requires no small amount of 
cautious and close investigation ; for there are many diseases 
closely connected with, if not actually depending upon spinal 
irritation for their existence; and hence spinal disease is often 
mistaken for inflammatory or other affections of various organs. 
Hysteria, and all the host of diseases termed nervous, are 
usually primarily or secondarily connected with spina 1 disorder; 
nor should the practitioner neglect, in any such case, a close 
and thorough examination of the spine, or fail to apply the 
remedies suitable to the treatment of spinal disease; for it 

74 Winn, on Spinal Irritation. [February, 

may save him the regret of mistaking this disease (as often 
happens) for dyspepsia, colic, hepatitis, disease of the heart, 
kidneys, uterus, &c. And no doubt many an unfortunate pa- 
tient has been made to undergo the tortures of a treatment for, 
first one and then another of these diseases, until he has pain- 
fully passed the ordeal of treatment for each, in succession, 
when, perhaps, a few cups or a blister to the spine would have 
at once relieved the sufferer. 

Our young friend, Dr. W. C. Brandon, of Floyd county, Ga., 
recently gave us the history of a case in point, which happened 
in the person of a lady who had been the subject of disease for 
ten years, during which time she had been under the care of 
several doctors, who, in their turn, subjected her to treatment 
for a whole catalogue of diseases, with which they alternately 
supposed her to be affected, ptyalizing her two or three times, 
and passing her through an ordeal of treatment for "dyspepsia," 
liver "complaint," gravel, &c. When called in, he found her 
confined to the parturient bed, suffering with ovaritis, and 
complaining of pain in the region of the liver, kidneys, of 
dyspeptic symptoms, and of a "hurting" between the shoul- 
ders ; but discovering (save in the ovary) no sign of inflamma- 
mation, except pain, he examined the spine, and on finding the 
four upper dorsal and lower cervical vertebras very tender, and 
some slight sensitiveness in the lumbar region, he had the upper 
portion blistered and sinapisms applied to the lower, which 
relieved those anomalous pains and the sense of "hurting" and 
" soreness" in the back and neck which had continued so long 
to annoy her, and (the ovaritis being in the meantime subdued) 
she, using occasionally vegetable tonics, soon found herself in a 
greatly improved state of health. 

But, with care, there need be but little danger of mistaking 
the disease, where there is supposed rheumatism, dyspepsia, 
hepatitis, nephritis, gastro-enteritis, &c, and no symptom pre- 
sent, except pain, of the existence of a phlegmasia, the physi- 
cian may at once be suspicious that he has a case of Spinal 
Irritation. Where spinal disease exists for a length of time, 
these and other affections may supervene from the irritation 
kept up in the part directly supplied by the diseased nerve, or 
nerve leading from the diseased portion of the spinal cord, or, 

1853.] Winn, on Spinal Irritation. 75 

more remotely, from the ganglionic nerves becoming involved 
ow account of their intimate connection with the spinal system, 
and, consequently, producing afunctional, if not structural, dis- 

We Blight enlarge upon the diagnostic symptoms between 
this and other diseases for which it might be mistaken ; but in 
most instances — such as hepatitis, pleuritis, dyspepsia, nephri- 
te — there are always evidences of the disease sufficient to 
prevent the mistakes to which we have alluded. The difficul- 
ty with young practitioners is too often a want of discrimination. 
If their patient complain of pain in a particular organ, the first 
impression on their mind is the existence there of inflammation, 
and having probably erred in the outset, a treatment is institu- 
ted accordingly. In all these cases of doubtful character the 
spine should be closely and thoroughly examined ; for in cases 
where the spine is not primarily affected, it may become so 
secondarily, on account of that reciprocity of action (before 
mentioned) which exists between it and the parts which it sup- 
plies with nerves. 

The prognosis of Spinal Irritation, perse, is not unfavorable. 
Where it is of long standing, we think it may probably bring 
on hydrorachitis, ramollissement, or possibly induration, which 
may produce death. 

In giving expression to this opinion of the probable results 
of this disease, we are not aware of having any written facts 
to sustain the supposition. We think it probable that a distant 
organ, kept irritated by a diseased nerve, or a nerve leading 
from a diseased portion of the cord, may eventually produce 
such a morbid action in the part as to result in death. 

Remarks upon the treatment of this disease need occupv but 
a small space, as it is simple and usually efficient. There are, 
perhaps, few or no diseases that give evidence of the therapeu- 
tic action of remedies earlier than the one under consideration. 
If the case is one of recent origin, and attended by any inflam- 
matory excitement, perhaps the detraction of blood by cups to 
the affected part of the spine will be the most suitable course. 
But if of chronic character, and the tenderness not excessive, 
simple vesication will accomplish the desired end. In case 
a protracted counter-irritation is desirable, pustulation with 

76 Wilson, on Empirical Remedies. [February, 

ungent. tart, antim. et potass, is advisable. §etons would 
accomplish the same result, though inadvisable if milder means 
will answer the end. Where the irritation is slight, or occurs 
in other diseases, as in intermittent and remittent fever, the 
application of sinapisms will frequently relieve the patient in 
an exceedingly short time. It may often be necessary to use 
some constitutional remedies in connection with the local 
treatment, as, for instance, when connected with dyspeptic 
symptoms, it may be necessary to use some mild cathartic and 
antacid. If general debility exist, tonics, vegetable or mineral, 
as the practitioner may think best, should be administered — the 
ferruginous preparations should never be omitted, if the patient 
is anemic or chlorotic. 

We might extend remarks upon the treatment of this dis- 
ease, and especially upon the treatment of those diseases con- 
nected with or dependent upon it — such as hysteria, chorea, 
perhaps some cases of dysmenorrhcea, &c, but we have 
already overleaped the bounds assigned to ourselves in this 

article v. 

Remarks on the Use of Empirical Remedies ; with some sug- 
gestions as to the best means of abating the evil. By John 
S. Wilson, M. D., of Air-Mount, Alabama. 

Dr. Robert Campbell, in an able essay,* recently published, 
has very appropriately compared the relationship of Empiricism 
to Medical Science, to the antagonism existing between virtue 
and vice ; for every one will be struck with the appositeness 
of the comparison, when he contemplates legitimate Medicine, 
with her noble aims, her "divinity of purpose," and her self- 
sacrificing devotion to the cause of suffering humanity — and 
then turns his attention to Charlatanry, with all its base tricks 
" for coining guilty gain,'*' with its numberless artifices to pros- 
titute Science to its unhallowed service, and its ceaseless efforts 
to impair the confidence of the community in those who are 

* An Essay on Empirical Remedies ; read before the Medical Society of the 
State of Georgia, April, 1852. By Robert Campbell, M. D., Chairman. 

1853.] Wilson, on Empirical Remedies. Tt 

the legitimate conservators of the public health, and the true 
expounders and guardians of medical science. To say, then, 
that empiricism and medical science are as much at variance 
as virtue and vice, or light and darkness — to say that physi- 
cians, by virtue of their position and education, are in duty 
bound to expose the tricks and fallacies of charlatanry and to 
warn a credulous and uninformed community against its impo- 
sitions, is but to utter a truism. Yet, while this is admitted by 
our profession, it is a lamentable truth that we have been re- 
creant to the responsible trust committed to us : the most of us 
"are prone to regard quackery, in its wide spread and rapid- 
ly increasing operation, with a bearing of complaisant regret 
and supine resignation, as a necessary and inevitable event."* 
Some among us "testimonialize for quacks" — some are en- 
gaged in the sale of their nostrums — while many prescribe 
them " without ascertaining their composition." And, alas ! 
there are some who have sacrificed honor, a pure conscience, 
professional respectability, every thing that adorns the man of 
virtue and of science, to lucre, and enlisted in the "legion of 
([iiackery /" I do not intend to review the influences which 
combine to sustain the "nostrum trade:" this has been ably 
done in the essay referred to ; and I do hope that its circula- 
tion will be co-extensive with its merits, and that it will receive 
the attention demanded by the importance of the subject dis- 

As the principal design of this article is to make some sug- 
gestions, as to the best means of counteracting the monstrous 
impositions of quackery, I have alluded to the humiliating dere- 
lictions, and the supineness of physicians, not only because I 
consider these to be the most potent auxiliaries of empiricism, 
but also because I think if the evil under consideration is ever 
successfully combatted, it must be done by our profession. It 
is true, that the influence of our noble profession has been much 
diminished by the protection afforded to quackery by legislative 
enactments, together with the low standard of education and 
morals among us: but I believe if this latter difficulty can be 
removed we can accomplish much, in spite of hostile legisla- 
tion : and I even cherish the» sanguine hope that we will finally 
♦Dr. Campbell"* Essay. 

78 Wilson, on Empirical Remedies. [February, 

be able to reform our legislators, and induce them to abolish the 
Patent Medicine Law, together with several State laws which 
are equally inimical to the public welfare, and the dignity and 
usefulness of the profession. 

As a proper appreciation of the causes of an evil is a desira- 
ble, if not an essential, pre-requisite in devising a judicious plan 
for its removal, no apology is needed for briefly alluding to the 
causes, which, in my estimation, have conspired to degrade 
Medicine, by transforming some of her legitimate descendants 
into quack-procurers and nostrum venders. The most influ- 
ential of those causes is, doubtless, the imperfect system of 
medical education among us, whereby many receive the 
honors of our colleges who are morally and intellectually 
incapacitated for a proper discharge of the responsible duties 
devolving upon them as physicians and men of science : and 
this defective svstem of education, I think, owes its existence 
to two principal causes — viz: 1st, the multiplicity of medical 
colleges, and the consequent rivalry ; and 2d, the disregard of 
the interests and respectability of the medical profession, mani- 
fested by our State legislatures, in the passage of laws which 
place every ignorant and unprincipled medicaster and half- 
educated licentiate on a footing of perfect equality with those 
who have been crowned with the highest collegiate honors, 
after years of laborious and expensive study. For in this 
utilitarian age, it can hardly be expected that our medical 
institutions will be very stringent in requiring high moral and 
intellectual attainments, when they know that these advanta- 
ges will bring to their alumni no legal protection or immunities ; 
while the majority of students, influenced by similar considera- 
tions, will flock to those colleges where they can "pass" with 
the greatest facility and expedition. These are serious obsta- 
cles to medical "reform;" but still I am fully persuaded that 
they can be obviated, by the combined action of the profession, 
through the medium of County and State organizations, and, 
above all, by co-operating with our National Association in its 
efforts to consummate the noble work for which it was insti- 

I shall, therefore, leave these rjemote influences in the able 
hands to which they have been committed, and proceed to 

1853.] Wilson, on Empirical Remedies. 79 

make some suggestions as to the more direct means of eleva- 
ting the moral tone of the profession, with regard to quack 
nostrums; and of thus depriving quackery of the encourage- 
ment given it by physicians. To promote this desirable object, 

until a more radical reform can be effected, I would suggest, 
1st. That the Faculties of our Medical Colleges make it a 
special duty to impress upon their classes their moral and pro- 
fessional obligations as physicians, and that they be warned, 
seriously and earnestly against compromising the dignity of the 
profession and the interests of the community, by giving quack 
certificates — by prescribing secret and unknown compounds, 
or by engaging in their sale. No one, who has read the histo- 
ry of medicine, or noted the tenacity with which students cling 
to the errors, even, of their instructors, will, for a moment, doubt 
the potency of their influence, when this is fortified by truth, 
by honor, and by professional interest and respectability. So 
fully am I convinced of the powers of our professors in the 
premises, that I can attribute the extent of the evil under con- 
sideration, only to a dereliction of duty, on their part, origin- 
ating either in indifference or want of a correct appreciation 
of their own influence: I would therefore invoke their atten- 
tion to these humble suggestions, and entreat them to avail 
themselves of their commanding position, by warning their 
pupils continually against any alliance with empiricism. 

I would suggest, 2nd. That all within the pale of the profes- 
sion, who, in any manner, encourage the use of patent or secret 
remedies, be u read out," and that they be declared unworthy 
of "the rights, privileges and honors of physicians'' — such as, 
1st, the privilege of a seat in any medical society or associa- 
tion; 2d, the honor of consultation; and 3rd, the right (con- 
ventional) of gratuitous medical attention in sickness. 

I will conclude these brief suggestions, by submitting the 
•'plan'' of the committee before referred to; and 1 would re- 
commend its adoption by the profession generally, as the best 
means of acting on the people — after the profession has been 
expurgated from empiricism. 

Plan. '"1st. The establishment of an efficient standing 
committee in this body, whose duty it shall be, with the assist- 
ance of the general society, to collect and publish, as far as 

80 Wilson, on Empirical Remedies. [February, 

practicable, through the popular channels of intelligence, all 
the instances of the pernicious effects, resulting from the em- 
ployment of empirical remedies, which may come under the 
observation of the society— -for the advisement of the people." 

In the above extract, I have taken the liberty of italicising 
the words " through the popular channels," &c, because I 
think that this mode of attack has not been properly appreci- 
ated by the profession: much has been written in exposition 
of the injurious effects of empiricism, and almost every medi- 
cal journal contains something of this kind ; but these disclo- 
sures never reach the people, and so far as their influence on 
them is concerned, they had as well be published in Hebrew, 
as in a medical journal. The popular channels of intelligence , # 
must be used then, to disclose the monstrous evils of quackery 
and the antidote thus made to accompany the bane. 

The 2d recommendation of the committee is, in general 
terms, as follows : — That the committee report the facts thus 
collected to the American Medical Association ; soliciting their 
recommendation of such a plan to the several State Medical 
Societies and Associations of the Union — "for the purpose of 
accumulating evidence sufficient for the arraignment of this 
injurious system, as a national grievance." And also for this 
committee to solicit the interference of the National Associa- 
tion, in memorializing the National Congress for the abolition 
of the patent medicine law, &c. — the evidence of the joint 
report of the several State committees being adduced as the 
reasonable apology for such application. 

Addendum. — Since writing the above, my attention has been 
arrested by the following requirement of the St. Louis Uni- 
versity. I transcribe it from the October No. of this Journal, 
for the purpose of giving it my hearty endorsement, and to re- 
commend its adoption by all our colleges, not only pro forma, 
but bona fide. 

" The Doctorate at the St. Louis University. 5th. And that 

* Besides the papers of the day, I would suggest that each State Society avail 
itself of that happy device of Gluackery— 'a Medical Almanac' and that the 
facts collected, together with some of the principles of Medical Science, be 
published in this, for gratuitous distribution. 

1853.] Moragne, on Snake-bite. 81 

he publicly assent to the following promise, prior to the confer- 
ring of the degree — viz : 

You, A. B., do solemnly promise that you will, to the utmost 
of your ability, exert your influence for promoting the welfare 
and respectability of the profession; that you will demean 
yourself honorably in the practice thereof; that you will not 
put forth any nostrum, or secret method of cure, nor engage in 
any other species of quackery; and that you will not publish 
any matter or thing laudatory of yourself, or derogatory to the 
profession; and in the conferring of this degree, it is done with 
the express understanding that the Faculty reserve to them- 
selves the right and privilege to revoke said degree whene 
the promise here made shall be violated." 


Bite of a Copperhead — " Trigonocephalies Contortix" — treated 
with Whiskey, By N. Harris Moragne. M. D., of Abbe- 
ville, South Carolina. 

On the 21st of June last, I was called to see a negro man 

belonging to Capt. P , of Abbeville district. Found him 

partially delirious ; skin hot and dry ; pulse very much excited, 
ranging from 100 to 120 ; left leg and ankle swollen to a great 
degree. Upon making enquiry into the history of this case, I 
learned that the patient had been bitten about twelve hours 
previously by a " trigonocephalus," or. as it is frequently styled 
in this part of the country, copperhead or highland mockesom 
This very poisonous reptile was concealed beneath the step of 
a meat-house, and inflicted a wound upon the inside of the foot,, 
near the ankle-joint. I immediately applied a ligature above 
the seat of affection — prescribed poultices over the wound; 
and olive oil, ammonia, &c, internally. 

22d. The patient is in statu quo — no abatement of the swel- 
ling, delirious: ordered whiskey, ad libitum. 

\t:id. Xo decided improvement — still anxious, restless, and 
uneasy ; skin hot and dry. Continued the whiskey, combined 
with capsicum : it was administered until the patient was fully 
under its influence, without regard to quantity. Left opiun? 
to be given if necessary. 

82 Dugas, on Lithotomy. [February, 

24th. Had passed the "crisis." A profuse perspiration was 
out over his entire s) T stem ; the tumefaction was subsiding ; the 
delirium had ceased ; he spoke rationally, and speedily conva- 

Gibson says — " Of the numerous American serpents, two 
species only are known to be poisonous — the crotalus or rattle- 
snake and copperhead." If he includes under the common 
name of copperhead, both the highland and the water-mocke- 
son,then we concur with him in the assertion. The two latter 
are of the same family, but not of the same species, which is 
abundantly manifest by their mode of living. 

The same writer says : " These reptiles are more lively, and 
their venom more active, during very warm weather. Upon 
the approach of the cold season, they become languid, and then 
strike reluctantly, and frequently without any ill consequence." 

The interesting case which I witnessed whilst a student in 
the University of New York, furnishes a striking proof of the 
speedy operation of the poison, even in the dead of winter. 

Dr. W., of that city, was bitten on the hand, by a rattle- 
snake, sent to him by a friend from the State of Alabama. The 
hand soon began to swell, and in a few hours the whole arm 
was very much tumefied, presenting a mottled appearance, even 
to the shoulder and axilla. He had the best medical advice 
the city afforded, yet, after intense suffering for two or three 
days, he died. 

I have no doubt, that if the alcoholic treatment had been in- 
stituted in this case, with the application of the ligature above 
the seat of affection, (which last was timely suggested by some 
•of the Southern students present,) Dr. W. would have recov- 


'Cases of Lithotomy. By L. A. Dugas, M. D., &c. 

However unimportant the report of individual cases in med- 
ical or surgical practice may sometimes appear, unless they 
offer new facts for consideration, they are not without value 
in a statistical point of view and in the collation of facts from 
Hvhich practical inferences are to be deduced. Were practition- 


1853.] Dugas, 07i Lithotomy. S3 

ers less backward in laying their experience before the pro- 
fession, whether successful or otherwise, a vast amount of useful 
information would be accumulated, to which systematic wri- 
ters could often refer with advantage. The three cases about 
to be placed upon record, are all of the kind operated upon by 
the writer during the past year, and will serve to show that 
surgical operations performed under the most favorable auspi- 
ces will sometimes terminate fatally, wheieas others may prove 
successful under the most unfavorable combination of circum- 
stances. There are therefore in surgery as well as in medi- 
cine, elements of controlling influence yet to be studied — yet to 
be appreciated. 

Case I.— Mr. John M. W., of Heard county, Ga., about 24 
years of age, had been suffering a number of years with stone 
in the bladder, when I visited him on the 10th day of March, 
1852. I found him confined to his bed, as he had been for 
some months, and suffering excrutiating paroxysms of pain 
about every hour when attempting to urinate. He appeared 
to be a man of robust constitution, although considerably de- 
bilitated and emaciated in consequence of his local affection. 
The general condition of his system seemed to be quite favor- 
able to the operation, so that, the calculus having been readily 
detected, we determined to remove it the next morning. 

The usual preparations having been made, I proceeded on 
the 11th, at 9, A. M., to the administration of chloroform, un- 
der the direction of Dr. J. Harriss. The patient was very 
soon brought under its full influence and the calculus removed 
by the bi-lateral section and the double lithotome, according tc 
Dupuytren's method. The whole time consumed was unuiually 
short, and the patient returned to consciousness in a few min<* 
utes, without having sutfered any pain. He expressed himself 
much gratified, was cleansed and put to bed, feeling as com- 
fortable as any one I ever saw under similar circumstances, 
and conversing with his friends. He continued so until after 
dinner, when, having other engagements, I left him in charger 
of his judicious neighbors, Doctors Redwine and Hunt. 

I subsequently received the painful intelligence that he died 
28 hours after the operation. Dr. Redwine, who furnished me 
the facts, states that a short time after my departure, the patM 

"84 Dugas, on Lithotomy. [February, 

became sick at the stomach, then restless, taking but short 
naps, and frequently calling for water; that he complained 
during the night of pain in the stomach and bowels; that the 
wound having become closed with coagula, bloody urine was 
passed per urethram, but resumed its course through the wound 
upon this being washed with tepid Water and a syringe ; that 
the loss of blood was very slight ; but that he went on gradu- 
ally sinking, without any evident cause, until 1 o'clock on the 
12th, when he died. 

Some might be disposed to attribute the fatal result to the 
Chloroform ; yet, when we reflect that the patient required 
very little of it to induce anesthesia — that he regained his con- 
sciousness and clearness of intellect in a few minutes, and that 
he remained so several hours before showing any unpleasant 
symptoms, such an inference would seem scarcely justifiable. 

Two calculi were removed, consisting of oxalate of lime* 
The larger of the two weighed 32 grains, was of irregular shape, 
being £ of an inch long, | an inch wide, and \ of an inch thick. 
The smaller one weighed 10 grains, was cylindrical, and meas- 
ured f inch in length and f of an inch in thickness. 

Case II. The subject of this case was Mr. Zac. S., of Lincoln 
county, Ga., aged 21 years, and upon whom I performed the 
Bi-lateral operation of Lithotomy on the 23d of June last, in 
the presence of Drs. M'Cord, Wilkes, Bently and Dunn. I am 
indebted to Dr. McCord for the following account of the pa- 
tient's history. 

"The first symptoms of stone were manifested in his early 
infancy, but did not assume a positive character until he was 
two years of age, when he was annoyed with straining, difficult 
and painfnl micturition, the flow of urine being sometimes sud- 
denly arrested. He continued in this state, being sometimes 
better and sometimes worse, until 14 years of age, when there 
appeared to be an almost complete subsidence of suffering, un- 
less he rode on horse-back. This kind of exercise would be 
followed by painful urination and the discharge of mucus. 
This deceptive abatement of the disease continued but a short 
time, after which all the previous symptoms returned. The 
least exercise would aggravate them, and he would pass large 


1853.] Dugas, on Lithotomy. 85 

quantities of blood and mucus with his urine. I first saw him 
in January last. lie had then frequent, urgent and ir resist able 
desires to pass urine, attended with straining, burning, and 
shooting pains along the urethra. The mucus would some- 
times remain mixed with the urine, and sometimes separate 
from it and form a deposit in the bottom of the urinal of a vis- 
cid tenacious matter, which would adhere to the vessel when 
inverted. The flow of urine appeared sometimes to be im- 
peded by it. There was great tenderness and pain over the 
region of the bladder, in the perineum and extending to the 

I visited Mr. S. on the 22d of June, and found him in bed, 
to which he had been uninterruptedly confined for upwards of 
six months. Emaciated in the extreme, without appetite, but 
great thirst, he experienced about every fifteen minutes (both 
night and day) the most excrutiating paroxysms of painful ef- 
forts to urinate. Worn down by long suffering, loss of sleep, 
impaired digestion, &c., he seemed to be on the verge of the 
grave. The sound revealed the presence of a calculus of some 
size, but it was very doubtful that he could, in his reduced 
condition, bear the operation required for its removal. There 
however, no time to lose, and, after frankly stating the 
unpromising prospect to the parties concerned, it was deter- 
mined to operate the next morning. Dupuytren's bi-lateral 
section was made, under the influence of chloroform, and 
an ammoniaco-magnesian calculus removed, which weighed 
two ounces and two scruples, was globular, its greatest diameter 
being 1 \ inches, and its least i\ inches. During the operation 
he fainted and appeared to be lifeless, but gradually recovered 
and was put to bed. A few hours after the operation, it was 
observed that the oozing of blood from the wound was greater 
than usual, and that in his debilitated condition it might be fatal, 
is checked. The usual means were adopted to lessen this 
hemorrhage, but it continued until midnight, rendering the free 
use of brandy and broth necessary to sustain life. The 1 
blood was not such as to have been serious to a patient less 
exhausted, but in this instance it was exce< dingly alarming. It 
was probably i ted by the great vascularity of the blad- 

der and prostate consequent upon such long standing irritation. 

n. ^. — von. ix. no. II. 6 

86 Dugas, on Lithotomy. [February, 

I left the patient, twenty- four hours after the operation, in 
charge of Drs. McCord and Bently. In three days he was 
fully convalescent, and gradually got entirely well. 

Case III. Stephen M., of Jasper county, 5 years of age? 
had suffered from stone in the bladder three years, when he 
was brought to this city by his mother in October last. His 
general health was but slightly impaired. Being put under the 
full influence of chloroform on the 21st. the bi-lateral section 
was performed as in the above cases, aud a calculus of uric acid 
removed. It was a flattened oval § of an inch long, | inch 
wide, and } inch thick, weighing 35 grains. The child rapidly 
recovered his health without any unpleasant symptoms. 

Remarks. — The first case terminated fatally, although the 
condition of the patient was as favorable as we usually find it 
in calculous persons, and no appreciable accident or complica- 
tion occurred to account for the result. Death took place too 
soon to have been induced by infiltration of urine or any in- 
flammatory process. There was no amount of hemorrhage 
sufficient to induce sinking. He recovered very soon from the 
influence of the chloroform upon the brain, and although the 
pain in the stomach (epigastrium) annoyed him some time, 
nothing is more common than lo find this effect of chloroform 
without serious consequences. This death must be put down 
to the account of what is called, for want of a better term, 
nervous exhaustion. 

The second case resulted in restoration to health under cir- 
cumstances of the most unpromising character. Whether the 
syncope was occasioned by the chloroform or not, is difficult 
to determine. He had inhaled very little of it. It is probable 
that had he breathed any more of it, the syncope would have 
been fatal. The oozing of blood still added to the danger ; yet 
he recovered, under the judicious management of his physicians 
and the good nursing of kind parents. 

The third case was successful, as they generally are in chil- 
dren when the operation is not too long deferred. 


1 853.] Clinical Illustrations of Sub-acute Ovaritis. 87 


(Eclectic Department. 

Clinical Illustrations of Sub-acute Ovaritis. By E. J. Tilt* 
M. D., Senior Physician to the Farringdon General Dispen- 
sarv and Lying in Charity, and to the Paddington Free Dis- 
pensary for women and children. 

The light oi' modern physiology thrown on many facts de- 
rived from the highest sources, enabled me, some years since, 
to apply to these facts the rules of reasoning adopted in gen- 
eral pathology, and I then endeavoured to give a wider and 
safer basis to our knowledge of the diseases to which the ovaria 
are liable, and by so doing, to lend my humble efforts to op- 
i tendency to consider the womb as principally affected 
in all diseases of women. Others have subsequently added to 
our information on these points; but I am not aware that my 
views have sustained any serious, attack. In the papers pub- 
lished in The Lancet, as well as in a work on "Diseases of 
3 1 mat ion and on Ovarian Inflammation,'' I avoided one 
chance of error by principally making use of facts registered 
by others, without any preconceived views of their import- 
I now propose to publish some of the cases I have met 
with, leaving others to decide how far they support the views 
I have put forth. 

Case 1. Emma W . twenty-two years of age, of mid- 
dling stature, and with red hair and grey eyes, was admitted 
to the Paddington Free Dispensary, July 1 I, 1851. She men- 
struated at twelve, and has ever since been regular every 
month, even during pregnancy and the ten months she suckled 
her child. For several months previous to, and since, wean- 
ing the child, she has suffered much from pain in both ovarian 
regions, which pain was always increased by menstruation, by 
walking, by pressure, by ascending the stairs, or by any sudden 
jar. Lately, the left ovarian region has become the most pain- 
ful, and the left breast has been likewise sore and swollen. 
For the last few weeks the legs swell at night; there is slight 
leucorrhcea, little \'c\'l-\\ and she complains of feeling "heavy 
for sleep," and would sleep on all day if she could. 

On making a digital examination, there was no sign of uter- 
ine disease, but pressure directed towards the left ovary was 
intensely painful. 1 ordered the following compound camphor 
mixture : — Solution of potash and tincture of cardamons, tour 
drachms each : tincture ofhyoscyamus, six drachms ; camphor 
mixture, six ounces: a tablespoonful to be taken three times a 
md a small quantity of the following powder to be taken 

88 Clinical Illustrations of Sub-acute Ovaritis. [February, 

in a little milk at night : — Sulphur, two ounces ; biborate of so- 
da, one ounce ; while three or four drachms of the following 
ointment were to be applied, not rubbed, over the lower por- 
tion of the abdomen : — Strong mercurial ointment, one ounce ; 
extract of belladonna, two drachms. I then directed a thin 
linseed poultice to be applied over the anointed surface, and 
over that a piece of oiled silk, with the understanding that this 
application was to be removed and re-applied as soon as pos- 
sible in the morning, at two or three in the afternoon, and be- 
fore disposing the patient for her night's rest. (I thus enter 
into minutiae, as their observance alone leads to success.) 

July 17th. The patient is better: the pains are only vio- 
lent at times; there is no leucorrhcea, and the bowels are com- 
fortably moved. 

2 1 st. Ovarian pains all gone ; the mercurial ointment is 
therefore discontinued. 

28th. I learnt that on the 22nd, after an attack of diarrhoea, 
menstruation returned ten days before it was due, but unac- 
companied by ovarian pains. I prescribed the following pills, 
to be taken at night : — Sulphate of quinine, one scruple; ex- 
tract of opium, Ave grains; extract of liquorice, a sufficient 
quantity to make ten pills. But upon leaving me, and before 
this treatment could be begun, menstruation again appeared, 
and there was a throbbing and swelling of both breasts, and 
pain referred to the pubis. On making an examination, I found 
the neck of the womb hot and swollen ; I ordered injections 
with a solution of acetate of lead, and I returned to the appli- 
cation of the compound mercurial ointment. I saw the patient 
after the subsequent menstrual period, which was normal as to 
time, quantity, and pain ; the womb was ascertained to be 
healthy, and the patient was quite recovered. 

This case was first one of sub-acute ovaritis, lasting for 
months, until the increased uterine activity, swelling of the 
womb, and irregular and prolonged menstruation, necessitated 
the employment of local measures to remove uterine conges- 
tion. The mercurial applications, however, should not have 
been discontinued on the subsidence of the ovarian pains ; for 
as the womb was in a healthy state on the 14th inst., if they 
had been continued, the slight attack of uterine disease would 
have probably been avoided. 

If I had not positively ascertained, on the 14th, that the 
womb was in a healthy state, I should, on finding it slightly 
diseased, on the 28th, have concluded that the previous pains 
were to be attributed to the beginning of undiscovered uterine 
affection, and not to ovaritis, which I believe to have been the 
primary affection, determining the uterine inflammation in the 

1853.] Clinical Illustrations of Suh-acute Ovaritis. 89 

same way that the physiological congestion of the ovary de- 
termined the physiological congestion of the womb in menstru- 

Cast. 2. Sarah II , thirty-two years of age, with black 

hair, grey eyes, and a Roman cast of countenance, was admit- 
ted to the Paddington Free Dispensary on the 2nd of June, 
1851. She first menstruated at fifteen, and has always been 
regular; but at each period she had suffered from pain in the 
right leg and (high. She married at twenty-one. Conception 
never took place. The last menstrual period came on eighl 
days before it was due, and was attended by a great increase 
of the pain habitually felt in the leg and thigh, The catame- 
nial flow lasted its usual time, but the pains did not abate on its 
disappearance, and in addition the patient suffered from con- 
stant pain in the right ovarian region, augmented by exertion, 
by walking, or by pressure. The water was freely passed ; 
the bowels, which were much relaxed during the last epoch, 
were now confined ; there was no leucorrhcea; and a digital 
examination indicated that the womb was healthy ; slight fe- 
ver : and pressure directed towards the right ovarian region 
increased the patient's pain. I ordered an antimonial mixture, 
and the compound mercurial ointment, directing it to be used 
as in the preceding case ; likewise the compound sulphur pow- 
der, as in the previous case. 

June 4th. Better in every way : the fever is reduced, the 
pain less intense, and pressure on the ovarian region determ- 
ines less pain. The ointment was ordered to be continued, 
and the compound camphor mixture as prescribed in the first 
case. A small quantity of carbonate of soda was ordered to 
be taken in a little cold water after meals, and two compound 
colocynth pills every night. 

Oth. The patient came limping into the room with tears in 
her eyes. The pain in the right thigh had left her, but that in 
the right ovarian region had returned with more intensity than 
before. There was difficulty in passing water. On making a 
digital examination, I found that the womb was lower down 
than on the 2nd June, and that its neck was swollen and pain- 
ful in its posterior half: no leucorrhcea. The patient was or- 
dered to continue the former treatment, and, in addition, to 
have, twice a day. as an enema, a cupful of clear starch, in each 
o\' which enemata were to be exhibited forty drops of laudanum. 

12th. Four enemata had been administered to the patient, 
and the pains had disappeared. I subsequently ascertained 
that at the nex ; j eriod she menstruated after her usual manner. 

The painful detected on the i)th of June, 

was certainly secondary to that of the ovary, since, on the 
2nd, the womb was found healthy. 

90 Clinical Illustrations of Sub -acute Ovaritis. [February, 

Case 3. Sarah W , a lymphatic girl, aged twenty-one, 

with light hair and blue eyes, tall and slender ; has been living 
in London, as a servant, for the last four years. Menstruation 
appeared at seventeen, after suffering for a month from head- 
ache and great drowsiness. From the third month of its first 
appearance menstruation came on regularly. It assumed the 
monthly type, lasting four or five days, and being in small 

Eight days before the last epoch, she was seized with intense 
pain in that portion of the left hypogastric region which cor- 
responds to the ovary. Notwithstanding the pain, she did her 
accustomed work, and menstruation came on at the regular 
time, and as abundantly as usual. Unfortunately she was at 
that time obliged to go up and down stairs much more than 
usual ; and far from being relieved by the catamenia, there re- 
mained an intense pain, which she compared to labour pains. 
She became hot, thirsty, and feverish at night, and she was 
admitted as a patient at the Paddington Free Dispensary on 
January 9th. I found the abdomen sore, particularly in the 
left ovarian region, where was also a sensation of fulness felt 
by the patient herself, and a slight swelling, which could not 
be detected on the right side. Walking or moving on the left 
leg. and pressure on the painful spot, increased the pain. There 
was no leucorrhoea, nor pain above the pubis. 

I ordered eight to the seat of pain, and poultices to 
be afterwards applied over the leech-bites; but as the tongue 
was foul, and there was a tendency to sickness and constipa- 
tion, I also ordered an emetic, and compound colocvnth pills. 

The leech-bites bled freely; the vomiting seemed to relieve 
the intense pain, which was, on the contrary, exasperated by 
the purgative action of the pills ; and when I saw her on the 
13th, she was better in every respect, and the intense pain was 
circumscribed in the left ovarian region. There was no pain 
above the pubis, no leucorrhoea, no external irritation. 

This intense pain produced by menstruation, so w 7 ell limited 
to an organ we know to be highly congested at that time, un- 
connected with uterine disturbance, with peritonitis, what is it ? 
Those who attribute to the womb all acute disease of the gen- 
ital apparatus, will say that the pain in the left ovary was the 
result of the uterine congestion determined by menstruation ; 
and as, in the absence of marked uterine symptoms, I did not 
feel myself justified in making a speculum or even a digital ex- 
amination, I could not object to the position, if, in similar cases 
(Nos. 1, 4, 6,9, & 10,) an examination had not been made, 
without any uterine disease being detected. Considering, 
therefore, the case to be one of sub-acute ovaritis, I followed 

1853.] Clinical Illustrations of Sub-acute Ovaritis. 91 

up the previous treatment by the use of mercurial ointment, 
as in the former cas 

10th. The patient was comparatively free from pain. 

27th. The ointment, pills, and mixture, were continued 
until menstruation came on at the usual time, ami in the usual 
manner. After it was over, the pain in the left side had com- 
pletely disappeared : hut on considerable exertion, or pressure 
on the right ovarian region, the patient experienced the same 
kind of pain, only less intense. She was directed to continue 
the use o( the ointment and poultice at night only ; and on the 
10th of February she was discharged cured. 

Case 4. Mary C , aged twenty-two, looked like a Flem- 
ish girl, very stout, with a ruddy complexion, auburn hair and 
blue eyes. She was admitted at the Paddington Free Dispen- 
sary, May 15, 1851. Menstruation had been easily established 
at sixteen, but had always been accompanied by a great deal of 
lumbo-abdominal neuralgia, appearing every month, or some- 
times missing for two. six. or nine months without any consid- 
erable inconvenience. She had been very lately married. On 
interrogating the patient, I heard that when menstruating, three 
weeks ago, the flow, after lasting two days, had stopped for 
three, and then returned for one day. Its subsidence was fol- 
lowed by a violent pain in both ovarian regions whenever she 
moved about. It hurt her to pass water. There is consider- 
able pain in the right breast, slight leucorrhoea, and considera- 
ble fever. Any sudden movement of the lower limbs brings 
on the pains, so does ascending the stairs, and pressure on the 
ovarian regions, particularly on the right, which I found swollen 
and tense; a state of things the patient expressed by saying 
" she was all on one side." A digital examination convinced 
me that the womb was normal ; the finger directed towards the 
ovaries greatly increased the pain, particularly on the right side, 
where a solid lump could be distinctly felt, while on the left 
side nothing similar could be distinguished, although pain was 
determined by pressure with the finger. The bowels were 
quite regular. I prescribed an antimonial mixture, and ten 
grains i^\ Dover's powder at night, the compound mercurial 
ointment to be spread on the ovarian regions, and the applica- 
tion of linseed-meal poultices. 

22nd. The !ever had abated, the pains in the back had dis- 
appeared, and tlmse in the ovarian region were less intense. 
The same treatment was continued. 

Menstruation returned at the third instead of at the fourth 
.. and had lasted its usual lime, when, from standing for 
three hours, it returned as a flooding, and continued for several 

92 Clinical Illustrations of Sub-acute Ovaritis. [February, 

June 4th. She was much better ; pressure on the right side 
still, however, brings on pain and a sensation of numbness in 
the right limbs. In July the patient had menstruated regularly, 
and was free from pain. 

If this was not a case of sub-acute ovaritis, developed under 
the influence of matrimony in an excitable girl of a sanguine 
habit, what is the disease to be called? The very abundant 
uterine discharge may have been considered critical in this in- 
stance, as it was followed by decided improvement. 

Case 5. Elizabeth W , twenty years of age, a brunette, 

dark hair, hazel eyes, of slender make and middling stature, is 
a needle- woman, single, and in good circumstances. After 
slight pains in the back, she menstruated at twelve ; was regu- 
lar from the first; the catamenia occurred every four weeks 
for three or four days, very abundantly. They had stopped 
for a year without any known cause, and they had returned 
without physic, being regular for the last three months, but 
much less in quantity, and paler in appearance than usual. She 
was admitted to the Farringdon Dispensary, January 8, 1850, 
complaining of violent pains in both ovarian regions, which 
pains had originated during the last insufficient menstrual flow, 
and had remained after its cessation. She also complained of 
a good deal of pain at the pit of the stomach, the intensity of 
which was said to be proportional to that experienced in the 
ovarian regions, increasing and diminishing as the latter in- 
creased and diminished ; but the pain at the prsecordial region 
was relieved by pressure ; while this measure increased that 
in the ovarian regions. There was great lowness of spirits, 
involuntary tears, invincible drowsiness, and a sensation of stu- 
pidity on waking. No uterine symptoms, no leucorrhoea, no 
fever or thirst.. 

I considered the case one of sub-acute ovaritis, and I ordered 
five leeches to each ovarian region, to be followed by the con- 
stant application of thin linseed poultices, and the compound 
camphorated mixture to be taken. 

22nd .The patient had been much relieved by the treat- 
ment ; the pains, instead of being continued, had become inter- 
mittent, occulting two or three times a day : she still continued 
drowsy. I ordered the mercurial ointment to be made use of 
as in the preceding case, an opium plaster at the pit of the 
stomach, and myrrh and aloes pills to be taken a day or two 
previous to her epoch. 

27th. After taking the pills, which procured three motions, 
the patient menstruated more freely than the last time, and 
with more than usual forcing pains. Two more -pills taken 
two days after the first, produced the same effect, and since 
menstruation is over, there is much less pain. 

1853.] Clinical Illustrations of Sub-acute Ovaritis. 93 

Feb. 3rd. I gave her lulphate-of-iron pills, and a Tew weeks 
after, aa menstruation had become norma), and the patient's 
health had bo much improved, she was discharged from the dis- 
pensary. In this, as in several of the preceding cases, the pa- 
tient complained much of feeling unusually heavy, dull and 
stupid, with a great tendency to sleep : a state of the nervous 
system which frequently expresses the physiological or morbid 
action of the ovario-uterine apparatus on the brain. As it is 
convenient to express this in one word, I call it pseudo-narcot- 
ism ; and it is right to remark that I have noticed this state in 
connexion with sub-acute ovaritis, in women who did not ha- 
bitually experience this pseudo-narcotism at the menstrual 

Case 0. Jane A , twenty years of age, of a sanguine 

complexion, reddish-brown hair, and blue eyes, tall and stout, 
is a washerwoman. After two years of great suffering, she 
menstruated at eighteen, the flow appearing regularly from 
the first every three weeks, lasting three or four days ; was 
of a trifling amount, and never missed until marriage, which 
took place at nineteen. Two months ago she miscarried, lost 
a great deal of blood, and since then has not menstruated. 
Admitted Jan. 13th, 1850, at the Paddington Free Dispensary. 
The patient complained of great forcing pain in both ovarian 
regions. She said the pain was increased by walking, by pres- 
sure, and by going up and down stairs. She also complained 
of severe forcing pain at the nipples, which was increased by 
the ovarian pains, as well as by anything hot she might take. 
There was no appearance of disease in the breasts, no leucor- 
rhoeal discharge, nor, on a digital examination, any evidence of 
uterine disease. I ordered the treatment prescribed in the 
former cases. The patient got gradually better, and at the 
next period she menstruated regularly. 

C \sr. 7. Emily B , admitted to the Farringdon General 

Dispensary, October 27th, 1851. She was twenty-three years 
of age, of a sanguine temperament, with reddish hair and grey 
eyes, and unmarried. Menstruation first appeared at seventeen 
and continued regularly every month; but for the last few 
months the excretion was very pale and scanty, and the last 
catamenial flow only lasted one day. and was attended by a 
good deal of pseudo-narcotism, leaving, without any known 
cause, a severe and constant pain in the right ovarian region, 
but during the day only: for when quiet in bed, the pain left 
her. The exertion of going up stairs increases the pain, like- 
wise slight pressure on the right side, while great pressure on 
the left ovarian region gives no pain. Slight leucorrhoea ; no 
fever; but the mouth looked as if painted with yellow dust; 


94 Clinical Illustrations of Sub-acute Ovaritis. [February, 

the tongue was furred, and the patient said she had been bilious 
for the last few days ; the bowels were regular. I ordered an 
emetic at night, the compound camphorated mixture before 
mentioned, and carbonate of soda after meals ; and the com- 
pound mercurial ointment to be applied in the usual way to the 
side affected. 

Nov. 1st. All pain and uneasiness had left the patient. 

loth. She returned on account of a cough, and I learnt that 
she had just menstruated, and that for many years the dis- 
charge had not been so abundaut, of so good a colour, and at- 
tended with so little suffering. 

In this amenorrhoeal form of sub-acute ovaritis there was 
no chlorosis. 

Case 8. Anne B , aged nineteen, with very dark hair, 

and eyes dark and lustrous, swarthy skin, and sanguine com- 
plexion, of average stature and size, and menstruated for the 
first time, without prodromata, at seventeen. Three months 
after its first appearance, the discharge re-appeared painfully, 
but with regularity, every fortnight, lasting three or four days, 
and was very abundant. Recently, after four months of amen- 
orrhea, menstruation returned of its own accord, much more 
abundantly, and with more pain, during which time, being ex- 
posed to wet, she caught cold, and was seized with violent pain 
in the right ovarian region, accompanied by considerable thirst, 
heat and fever. Another gentleman had attended her at her 
own house, and ordered twelve leeches to the seat of pain, 
poultices, and some medicine; and after being confined to her 
bed for a fortnight, menstruation returned at the usual fort- 
nightly period, with more clots and greater pain, and lasted 
seven days, instead of three or four. 

On the 20th of February, 1850, she was admitted to the Pad- 
dington Free Dispensary. The pain in the right ovarian region, 
although much abated, was still considerable, and was exasper- 
ated by stooping, walking, or by pressure. No leucorrhoeal 
discharge. I ordered the usual compound camphor mixture, 
the ointment, poultices, and two grains of sulphate of quinine, 
with two of extract of hyoscyamus, in a pill, every night ; but 
before the treatment was begun, the patient again menstruated, 
and the function lasted with -great pain for three days; and on 
its disappearance, a light leucorrhoeal discharge ensued. The 
treatment was then put in force, the local pains gradually dis- 
appeared, and on the 4th of April I heard that menstruation had 
re-appeared at monthly periods.* 

Aug. 11. She applied again, for an attack of jaundice; and 
I learnt that she had not again suffered from pains similar to 
those which brought her before to the dispensary. 


1853.] Clinical Illustrations of Sub-acute Ovaritis. 95 

Dec. 1851. Anne B again called, and stated that, during 

a severe cold, menstruation came on at the usual time, lasted 
eleven days, ceased by degrees ; and that upon its cessation, 
the ovarian pains, bearable before, became intolerable, causing 
her to walk doubled, particularly when going up stairs. She 
could not wear her stays, pressure determining a darting pain. 

It is interesting to observe how. in this patient, the menstrual 
function, which by the use of sulphate of quinine, I had brought 
to the tour-weekly type, soon relapsed from the normal to the 
three-weekly, and then again from the three-weekly to the fort- 
nightly, which it now adopts; and how, in close correspond- 
ence with these irregularities of physiological action, there is 
also a tendency to relapse into the morbid condition, which I 
think deserves to be called sub acute inflammation. 

Case 9. Dr. Yinen, of Bayswater, requested me to see a 

patient of his, in September, 1849. Mrs. L was then 

twenty-eight years of age, with a pale complexion, middling 
stature, dark hair, and hazel eyes. She had first menstruated 
at twenty, but was always irregular both as*totime and quan- 
tity, it being sometimes scanty, at others very profuse. Since 
marriage the function had become more regular, but was still 
variable in amount 

In the previous January she complained of acute pain in the 
right ovarian region. Two months after, consulting Dr. Yinen, 
he discovered a distinct swelling in that region, and, some 
weeks after, the same appeared on the left side, accompanied 
by great tenderness at all times, but particularly at the men- 
strual epoch. The catamenia then became more scanty, dark- 
er, and more painful than usual. There was dorsal pain and 
slight leucorrhoea. Twelve leeches had been applied, with but 
little benefit, but blisters had been more efficacious. When I 
saw the patient she was exhausted by continued suffering, and 
was at times affected with hysteria. Menstruation had not 
appeared for the last two months. Digital examination was 
painful both to the vagina and to the womb, which was some- 
what swollen : there was acute pain on pressing in the direc- 
tion of the ovaries, the right one being still swollen ; both 
breasts were very painful. I ordered the treatment previously 

On the 1st of August the patient was better: examination 
was no longer painful; pressure in the ovarian regions was 
less so ; the womb was neither swollen nor painful, neither did 
it present any lesion when examined through the speculum. 
In addition to the previous treatment, I ordered cold-water 
injections to be made twice a day, per rectum, and twice a day 
a vaginal injection of two drachms of tincture of hyoscyamus 
in half a pint of tepid water. 

9G Clinical Illustrations of Sub-acute Ovaritis. [February, 

The patient rapidly improved, lost all pains, and became 
stronger. She has had no relapse, bat, although married sev- 
eral years, has never been pregnant. 

Case 10. Charlotte K called upon me October 18, 1849. 

She was about twenty-six years of age ; her constitution being 
lymphatic, but her hair and ey^s dark. In childhood she had 
several abscesses in one of her legs and groin. Menstruation 
appeared at fourteen, but at sixteen was suspended, from her 
catching cold : and when it did return it was three-weekly 
instead of monthly as before. It was either profuse or scanty, 
and preceded for a week by great pain in the ovarian regions. 
Pressure, walking, or stooping, aggravated this pain. This 
state lasting for several years, had brought dyspepsia, palpita- 
tion, hysterical symptoms, and there was often leucorrhoea. 

Mr. Pughe, of Aberdovey, in North Wales, considering the 
case to be one of chronic ovaritis, sent her to me. Digital ex- 
amination was so painful, that I contented myself with having 
ascertained that the vagina and neck of the womb were swol- 
len, hot, and inflamed. Pressure on the ovarian regions was 
also very painful. Leeches had been appied to them a fort- 
night previously, and with great benefit ; I therefore ordered 
twelve more to be applied, prescribing the usual treatment, 
with the addition of aloes pills, and cold-water injections per 

Oct. 28th. I was able to make a speculum examination, and 
ascertained that there was no ulceration of the womb, which I 
was led to expect from the persistence of many symptoms 
which usually indicate it. When the finger in the vagina was 
directed towards either of the ovaries, a sickening pain was 
determined ; and when the left hand pressed moderately on the 
ovarian region, so as to press the mass of intervening tissues 
between both hands, the pain became intolerable. 

This patient was fox several months under my care. After 
each menstrual epoch, six leeches were applied to each ovarian 
region ; when the leech-bites had healed, a blister was applied 
to the same part ; and when these were healed, the same sur- 
face was anointed with mercurial ointment until the time when 
menstruation made its appearance. 

Feb. 13th, 1850. She was without pain or discharge, and 
menstruation had assumed its normal type, completely losing 
the prolonged pains by which it had been accompanied. In 
fact, she returned to Wales quite well. 

As the preceding cases are fair samples of many others 
which I have met with, it may be well to see to what deduc- 
tions they lead. 

1st. With regard to the predisposing causes of sub-acute 

1853.] Clinical Illustrations of Sub-acute Ovaritis, 07 

ovaritis, Irregularity of the menstrual process is one of the most 
frequently observed ; for eight times out often it occurred in 
connexion with menstruation. The earlier part of womanhood 
also would seem most liable to this disease, as seven out often 
patients were under twenty-three, and the eldest was only 
thirty-two. Those too are most liable to it who are endowed 
with a sanguine constitution, dark eyes, and red, auburn, or 
black hair, constitutional peculiarities generally supposed to be 
allied to an ardent temperament. In this, my experience is 
supported by thai of Dr. Pistocchi, of Bologna, who has lately 
published some interesting cases of ovaritis, and says that all 
the patients were women gifted with strong passions. Six out 
of the ten patients were single. 

2nd. The determining causes were over-exertion during 
menstruation, the sudden impression of cold, marriage. In five 
cases, however, none could be discovered. 

3rd. The symptoms : pain in one or in both ovarian regions. 
The pain being fixed, but sometimes subject to irregular ex- 
acerbations, being increased by pressure, by going up and 
down stairs, by a false step, or by anything that could jar the 
corresponding limb. It is well to notice that pressure on the 
ovarian regions did not generally determine pain in the course 
of the lumbo-abdominal nerves. In two cases the pain was 
accompanied by an amount of abdominal swelling discernible 
to the eye, obscuiely felt on pressure on the abdomen, better 
appreciated by a vaginal examination, and which would have 
been made certain if a rectal examination had been deemed 
requisite. In five cases there was considerable pain and swel- 
ling of the breast corresponding to the side afiected, and of both 
when both sides were diseased. This symptom was most 
marked in Case (>, which did not occur at a menstrual epoch. 
Dr. Pistocchi has noticed it in two cases; but I think Dr. 
Lightfoot has gone too far in considering it as pathognomonic 
of ovarian inflammation. Thus, the mammary glands, the 
uterus, and the ovaries, form a chain of organs as strongly 
linked together in the morbid as in the physiological state. In 
1 there was numbness and pain in the corresponding limb, 
a symptom noticed by Dr. Simpson. In four cases there was 
fever, but of do great intensity. 

4th. The terminations or morbid conditions induced by sub- 
acute ovaritis were, a painful congestion of the womb in four 
out often instances : in three, remittent menstruation ; a defi- 
ciency of the menstrual excretion in three more; and in two, 
bilious plethora. Dr. Rigby has dwelt on the sickening nature 
of the pain determined by ovaritis: and Dr. Wool ley, of 
Brompton, tells me he has often seen cases similar to those 

98 Clinical IHustralions of Sub-acute Ovaritis. [February, 

above described by me, and frequently noticed sickness as one 
of the symptoms. Dr. Laycock alluded to it some time back 
as a symptom frequent in this, as in all ovarian states, both 
physiological and morbid. 

5th. Treatment. — The same local measures previously de- 
scribed were always adopted, with the addition of leeches and 
the internal exhibition of antimonials when there was fever. 
In the cases coinciding with marked biliary derangement, I 
prefaced all treatment by an emetic, the temporary increase of 
pain thus mechanically determined being amply compensated 
by the relief speedily afforded to the patient. Sulphate of 
quinine was very useful in bringing back menstruation to its 
normal type ; and I cannot too strongly recommend its exhibi- 
tion alone, or combined with steel or opium, according to the 

6th. Duration of the disease : Generally about twenty-one 
days; but in one case, of probable long standing, it was four 
months, and in another there was a relapse. 

With this summary of my cases I might conclude, if they did 
not afford me an opportunity of offering some remarks on the 
diagnosis of sub-acute ovarian affections — remarks, the length 
of which will perhaps be indulgently received, on account of 
the recognised difficulty of arriving at a correct diagnosis. 

Cases similar to the preceding have doubtless been of fre- 
quent occurrence, but they have been differently interpreted. 

I. Formerly when they were met with, and sometimes even 
now, particularly when they do not occur at the monthly peri- 
ods, they were confounded with diseases of the womb, and 
called inflammation of the bowels — a name w T hich will doubt- 
less be considered erroneous, as far as the localization of the 
disease is concerned, but which, being correct in the indications 
of its nature, fortunately often leads to proper treatment. 

II. When cases similar to those I have reported took place 
at, and in connexion with, the menstrual periods, they were, 
and are even now, confounded with many other morbid states, 
under the name of dysmenorrhoea. They are considered to 
be merely an increase of that pain by which menstruation is 
usually attended, and generally left without treatment. This 
I believe to be often detrimental to the patient's after health. 

III. Some would be inclined to explain my cases by incipient 
uterine disease, and might be impelled by theory to resort to 
measures, excellent in uterine, but unnecessary, if not danger- 
ous, in ovarian disease. Being in doubt as to four out of the 
ten cases, a digital examination convinced me that there was 
no uterine disease; and in the history of the other cases there 
was nothing to make me suspect its existence, nor to warrant 
a vaginal examination. 

1853.] Clinical Illustrations of Sub-acute Ovaritis. 90 

Admitting that mine were neither cases of inflammation of 
the bowels, of dysmenorrhea, nor of uterine disease, I must re- 
mark that they can only he explained by supposing them to 
depend on a nervous affection of the ovary itself, or of the 
lum bo-abdominal nerves, which supply alike the womb and the 
ovaries and their protecting cavity, unless I am right in con- 
sidering them to exemplify a subdued type of ovarian inflam- 
mation. It would be impossible for me to show that they did 
not depend on ovaralgia or lumbo-abdominal neuralgia, unless 
I be permitted to clear the ground by a lew remarks on these 

Ovaralgia has been admitted by systematic writers, vaguely 
described by German pathologists, and lately brought promi- 
nently forth under the name of ovarian irritation, by Dr. Fleet- 
wood Churchill. But while admitting that the ovaries, like the 
uterus, may express their own disorder by pain transmitted to 
the same system of nerves, we must also bear in mind that those 
nerves may take upon themselves a morbid action, quite inde- 
pendent of diseased ovaries or womb — that lumbo-abdominal 
neuralgia may exist. 

Certain forms of lumbo-abdominal neuralgia were well de- 
scribed by Chaussier ; but it is only since the modern inves- 
tigation of the nervous system, that it has been permitted 
satisfactorily to explain, by lumbo-abdominal neuralgia, certain 
morbid states formerly ascribed to the abdominal viscera. 
Without pretending to say that ovaralgia does not exist, I must 
own that I have never as yet been able to detect it, and am 
inclined to think that cases described as such are to be referred 
to lumbo-abdominal neuralgia. I make this assertion with some 
hesitation, because by so doing I find my opinion opposed to 
that of an obstetric authority of so great a value, that by differ- 
ing from it 1 incur the risk of being wrong; but, if wrong, my 
dissent will furnish Dr. F. Churchill the opportunity of more 
forcibly vindicating his own opinions. 

On perusing Dr. F. Churchill's interesting communication on 
Ovarian Irritation, in the impression of the Dublin Medical 
to for July, 1851, and comparing it with what Drs. Beau, 
Valleix, and #ome other French authors, have written on 
lumbo-abdominal neuralgia, it will, I think, be evident that they 
have all described the same disease. Neither would it be diffi- 
cult to explain the mistake ; for it is well known that it is in the 
nature ot the affections of nerves to be attended by pain more 
concentrated in certain points, whence at times pain radiates, 
and pressure to which increases pain. The lumbo-abdominal 
neuralgia is often indicated by one or more of the following 
foci of pain: 1, the lumbar; 2, the iliac: 3, the hypogastric ; 
4, the inguinal ; 5, the uterine. 

100 Clinical Illustrations of Sub-acute Ovaritis. [February, 

I think that Dr. F. Churchill, being particularly struck by the 
inguinal or ovarian point of pain, has described, under the name 
of ovarian irritation, a complaint which has been justly referred 
to a morbid sensibility of the lumbo-abdominal nerves by Drs. 
Valleix, Oxenfield, Beau, and others. He has followed in this 
the example of Gooch, who described as irritable uterus those 
cases of lumbo-abdominal neuralgia in which the neck of the 
womb is the principal centre of pain; an example already set 
by neuro-pathologists, who have described as spinal irritation 
an ill-defined group of symptoms. 

I refer the reader to Dr. F. Churchill's paper, and to the 
French authorities I have quoted, in proof of the great simi- 
larity, if not identity, of the morbid state described as ovarian 
irritation or lumbo-abdominal neuralgia. But, under all cir- 
cumstances, I object to the term ovarian irritation, because it 
has already been employed to express the physiological action 
of the ovaries, and imports another vague and indeterminate 
term into ovarian pathology, already sufficiently obscure. If 
it be only pain, let it be called ovaralgia, or lumbo-abdominal 

Supposing it to be conceded, until further researches, that 
ovaralgia is but another name for lumbo-abdominal neuralgia, 
then it only remains to me to establish the diagnosis between it 
and sub-acute ovaritis, which is often rendered difficult by the 
similarity of the seat of pain in both complaints. Those of a 
nervous temperament are most liable to lumbo-abdominal neu- 
ralgia, not brunettes of a sanguine constitution, as in most of 
the cases given in the previous papers. Pain exists in all, but 
while in sub-acute ovaritis it is more fixed, continues with the 
same intensity without regular exacerbation, and is exasperated 
by every kind of pressure, in lumbo-abdominal neuralgia it is 
quite the contrary; for although there may be at all times a 
dull, aching sensation, it is frequently not so, and the pain re- 
curs by repeated attacks, and is relieved by wide or even by 
continued pressure with the united tips of the fingers. Dr. F. 
Churchill rightly says, that what he terms ovarian irritation is 
characterized by a kind of nervous tenderness which shrinks 
from the weight of the finger as much as from ^vere pressure, 
and not by the positive pain, as in my cases. 

There is no swelling, no heat, no pain of the ovaries, when 
these organs are subjected to a rectal examination, as correctly 
stated by Dr. F. Churchill, whereas there is heat, swelling and 
pain, in sub-acute ovaritis. 

The pain is unaccompanied by any sympathetic pain of the 
breasts, or fever, in lumbo-abdominal neuralgia; not so in sub- 
acute ovaritis. Lumbo-abdominal neuralgia is so frequent an 

1853.] Clinical Illustrations of Subacute Ovaritis. 101 

accompaniment of uterine disease', that Dr. Beau and others 
expect to find it when the former < xists, and Dr. Ben n el looks 
upon its o\ arian tonus as almost pathogt omonic of uterine dis- 
ease, while sub-acute ovaritis is not so frequent I) induced by 
uterine disease. Lastly, with regard to the treatment. Re- 
peated blisters and opium are of most w<a iu lumbo-ahdominal 
neuralgia, but such remedies, valuable in the later stages of the 
disease, require to be employed after leeches, emollients, &c, 
in sub acute ovaritis. 

Il my argumentation is not at fault, then my ten cases were 
examples of sub-acute ovaritis ; and. moreover, the complaint 
can be diagnosed with a degree of precision quite sufficient for 
all practical purposes, without having recourse to any internal 
examination. It was so in six out of the ten cases, while digi- 
tal examination was necessary to establish the diagnosis in 
four, but a rectal examination in none. 

Taught by former experience, wherein the coincidence of 
sterility or uterine disease rendered imperative a more accurate 
examination, I concluded from the symptoms narrated that the 
s were sub acutely inflamed, although my finger did not 
Bel them swollen, although I did not see the patienl wince 
[mderthe moderate pressure of the finger mediately applied to 
ins; but I maintain that win-never the case is com- 
plicated or great pressure is required, it is necessary to make a 
initiation. From not having done so in the following 
case. I (\',A not understand the whole of its bearings, and some 
irsmay think lint I was completely wrong. 

Cask II. Sarah X , twenty-three years of age, is tall, 

of slender make, with light brown hair and grey eyes : she is a 
washerwoman in good circumstances. Alter painful prodro- 
six months, menstruation first appeared at thirteen, 
and at once assumed the monthly type, lasting five days, and 
being very abundant, bright and clotty. She was married at 
. and iias had two children, and during both lactations, 
ged to the thirteenth and twentieth mouths, menstrua- 
tion occurred every fourteen days with unusual abundance. 
Three months previous to her applying to me for relief, she 
who judiciously told her to wean the 
child. On doing so, menstruation returned to the monthly 
abundant ; but while still debilitated by 
thee' labitually profuse menstruation, and about the 

time when it should ha i _ r »t wet through, caught 

attended by d instead of the cufamenia 

appearing, the patient was seized with . pains in both 

ovariai ed by her as bearing down and pinch- 

pains, and augmented by standing long or by pressure. 

N. S. VOL. IX. NO. II. 

102 Clinical Illustrations of Sub-acute Ovaritis. [February, 

There was no leucorrhcea and no pain about the pubis when, 
January 13th, 1850, she applied for relief at the Paddington 
Free Dispensary. I ordered five leeches to each ovarian re- 
gion, and the usual treatment ; but not hearing anything more 
of the patient, T sought out her abode, and learnt that she had 
derived benefit from the treatment, but that having been 
obliged to exert herself more than usual, on account of her mo- 
ther's illness, she had miscarried of a three-months foetus three 
weeks after coming to the dispensary. 

Dr. Rigby admits that ovaritis is one of the most frequent 
causes of abortion, and possibly my diagnosis was correct, and 
a relapse may have brought on the miscarriage. This view 
seems to be confirmed by the great, tendency to exaggerated 
ovarian action ever since the patient first menstruated, while 
the sudden invasion of acute pain in the ovarian region, in con- 
sequence of menstruation being interrupted by a feverish cold, 
would certainly again cause me to give a similar diagnosis ; 
but I abandon the case, as it admits of more than one interpre- 
tation, and. merely bring it forward to show that I acquired but 
a very imperfect knowledge of it, because I neglected a vaginal 
and rectal examination. If the patient had been thus examin- 
ed, early pregnancy would have been detected, and she would 
have been warned against the excess of fatigue which caused 
the death of the embryo, and the prolonged illness of the pa- 
tient. This case is well worth the attention of those medical 
men who object to a rectal examination on the ground of its 
being an unclean practice; as if a medical man can be stopped 
by such a consideration when health is at stake ! 

We cannot conclude without observing that sub-acute in- 
flammation of the ovaria does more than cause temporary 
ill-health : it may determine or be accompanied by ovarian 
peritonitis, and even set up inflammation in the surrounding 
portion of the peritonaeum. Many obstetric writers, as well 
as Burns, Sir C. M.Clarke, and Dr. R. Lee, have noticed the 
great frequency of lesions of the ovaria, and of false mem- 
branes in their vicinity, even in unmarried women — lesions 
not to be accounted for by any previous severe uterine dis- 
ease, from which it could be ascertained that the patients had 

With regard to peritonitis, I will merely cite the practice of 
one London hospital, St. George's, where the post-mortem ap- 
pearances are noted with a praiseworthy care. In 1850 the 
medical practice afforded four instances of idiopathic peritoni- 
tis; three occurred in young women of twenty, twenty-one, 
and twenty-four years of age; with two the menstrual func- 
tion was deranged, and the patients anaemic ; the third, though 

1853.] Clinical Illustrations of Sub-acute Ovaritis. 103 

man ten months, had had no children, and, after 

rag pus in her stools, she recovered. 

.. it seems tome that the cases I have previously related 
are explanatory of those of peritonitis. Again, there is a form 
of peritonitis to which women are more subject than men. in 
which bridtes of lymph are so attached as to hind the intestine, 
and produce fatal incarceration Why should such bridles be 
frequent in the vicinity of the ovaria? I will nnswer 
tfiis question, as I found it in one of the last imp: :' the 

London Medical Gazette. An eminent pathologist, I >r. Renaud, 
of Manchester, relates the death of a girl, twenty-one years of 
age, from two bridles of lymph, which produced an impenetra- 
ble stricture of the ileum, and nddsthe following reflections: 

- My own experience in pathological anatomy, and a perusal 
of the cases recorded by others, justifies the conclusion that 
peritonitis in femal in many instances out of a chronic 

form of congestive irritation, to which the generative appara- 
t bin the abdomen is liable. That this long-continued 
irritation, as manifested directly by pain and throbbing in the 
region of the ovaries and uterus, and indirectly by lumbar irri- 
i, dysmenorrhea, crural pains, &c, does frequently ad- 
vance to local inflammatory action, is sufficiently evident from 
3 of lymph that are so frequently seen matting the 
ovaries, broad ligaments, and oviducts together. If therefore, 
folds of bowel or portions of omentum are in contiguous rela- 
tionship wit!) parts influenced by these morbid actions, it is not 
contrary to rational pathology to infer that they will partake 
in a limited decree of the same actions; and a bond of union 
being thus morbidly constituted, it only requires time and the 
peristaltic action of the bowels to elongate the lymph into a 
hai d, which, under accidental circumstances, may prove an 
incarcerating medium." 

Rokitansky is likewise of opinion that internal constrictions 
of the intestines, are much more frequent in females than in 
males : a result which indeed might have been anticipated, on 
account of the great changes in function, structure, and posi- 
tion, to which the abdominal viscera are subject, by menstrua- 
tion, | v, and from uterine and ovarian tumours ; and 
,ied author also reports that — 

"'In two instances with which I am familiar, the pressure of 
the prolapsed ovarium, loaded with purulent fluid, produced in 
each i • d form «»l ileus. In one of these the tumour filled 

the rectum: neither bougie nor inj-etion could be com 
beyond it, and such was its apparent solidity, that I did not \\>[- 
a momenl contemplate puncturing. But the deception was 
fatal to the patient. The second case, very similar in all re- 

104 Ricord's Letters on Syphilis. [February, 

spects to the first, occurred in the practice of a surgeon in the 
country, who sent me its history, and the morbid parts for ex- 

The pith of the present communication can be summed up 
in a few words: 

I. It seems urgent on us carefully to bear in mind the fre- 
quency of inflammatory products in or about the ovaries, the 
frequency of intense suffering in the ovarian regions at the 
menstrual periods, and the great probability of both facts stand- 
ing one to the other in the relation of cause to effect. 

II. It seems incumbent on us to bear in mind the greater 
liability of young women to idiopathic peritonitis, and incar- 
ceration from bridles of inflammatory lymph, at the very age 
when 1 have shown that even the sub-acute inflammation of the 
ovaries is most frequent, and therefore the imperative necessity 
of watching over the first stages of a complaint, which, being 
too of* en left to nature, is as frequently productive of serious 

III. Lastly, that sub-acute ovaritis can be distinguished from 
uterine affections as well as from lumbo-abdominal neuralgia, 
but that at all events no harm can ensue from the treatment 
recommended. — [London Lancet. 

Letters upon Syphilis. Addressed to the Editor of L'Union 
Medicale, bv P. Ricord. Translated from the French, by 
D. D. Slade, M. D. 

[Continued froin Page 682, vol. 8.] 


My dear Friend, — I promised to commence to-day the great 
questions to which the study of blennorrhagia gives rise. I shall 
endeavor to do honor to this serious engagement ; serious in 
fact, for. as I hope to be qualified to show, the point that I un-' 
dertake to discuss at this moment may be considered as the 
key stone to the syphilographic edifice. 

All that I have thus far said upon blennorrhagia, relates to 
simple blennorrhagia, which may be considered or not as the 
product of a special virus, but a virus completely foreign to 
that which syphilis, properly called, produces. However, this 
blennorrhagia, according to a great number of authors, can pro- 
duce consecutive accidents perfectly identical to those which 
chancre produces. It is incontestable that a great number of 
patients, affected with constitutional syphilis, do not accuse 
for antecedents anything but blennorrhagia. These patients 
are sometimes right. I do not deny the fact ; but after having 


1853.] RicorcPs Letters on Sj/jihilis. 105 

verified it. I do not confine myselfto leaving it in a crude state, 

and to crying out with emphasis, it is a fact, and then oppose it 
with intolerance. 

The entire question enn be reduced to these term . when a 
blennorrhagia has been the point of departure ofa constitution- 
al syphilis, has there not been something else than that which 
we have before studied in blennorrhagia properly so called ? 
Experimentation has proved, and pathological anatomy has 
come to its aid. that the urethra, and the deep and cone 
points of the other genital mucous surfaces, can be the seat of 
chancre, the necessary souice of syphilitic accidents. It is for 
not having recognized the concealed chancre, thai the doctrine 
of Balfour, of Tode. of Bell, and that great scaffold built upon 
the experiments of Hernandez, have very nearly given way. 

With the doctrine of the existence of urethral or concealed 
chancre, the virulent blennorrhagia cannot be doubted ; it is 
identical with chancre, it is the chancre itself. 

This idea is not new in science, and I am astonished that the 
detractors from priority have brought nothing against me in 
this respect. However, it is a lon<j time since the ulcerations 
of the urethra were recognized. Mayerne, in the seventeenth 
century, attributed at that period the urethral blennorrhagia 
to pus produced by ulcers within the urethra, and nave to it 
the name of pyrroia. Many others still; whom I do not wish 
to recall, have verified the presence of ulcerations in the ureth- 
ra; but do you not consider it strange to see Swediaur, who 
sustains the identity of blennorrhagia and of chancre, say pre- 
cisely that which cannot be denied, viz, that blennorrhagia is 
virulent when ulcerations exist in the urethra! 

If in three autopsies of persons hung, who were affected 
with blennorrhagia, Hunter did not prove the presence of ulcer- 
ations in the urethra; it in an autopsy of which M. Phillippe 
Boyer has given an account ; if in some others still nothing 
has been found, it is because they had to do with simple blen- 
norrhagia. I have shown to the Academy of Medicine two 
specimens of pathological anatomy, the designs of winch and 
the accompanying observations may he found in the cltmque 
iconogrdphique of the Venereal Hospital, and upon which 
MM. Culierier and Lagneau have made a report. These spe- 
cimens presented some chancres of the urethra at different 
depths, which previous to death had been recognized by inoc- 

Thus, inoculation Brit, and pathological anatomy afterwards, 
have pr >ved, in an 

cres of the urethra. To tell the truth, i - it, even 

those who wish to ascribe to simple blennorrhagia the conse- 

106 RicorcTs Letters on Syphilis. [February, 

quences of syphilis. The chancre concealed in the urethra is 
not, then, an hypothesis, but a fact proved as certainly as any 
other medical fact. And vet, singular phenomenon! those 
even who have best studied the chancre of the urethra — who, 
like M. Baumes, have been able to recognize it at the depth, of 
an inch in the canal — when it comes to establish the logical de- 
ductions of its existence, love better to launch into the field of 
hypothesis, thcin to admit that which observation and good 
sense point out to them. Observe, in fact, M. Baumes and 
others, establish, with a rare sagacity, the differences which 
exist between chancre and blennorrhagia, in tracing with clear- 
ness the differential characteristics, and arriving, at the end of 
his comparison, to conclude upon the identity of these two ac- 

It is always, dear friend, the same contest between the logic 
of facts and the pieconceived ideas of which I have noticed 
the results even in the great mind of Hunter. Very recently 
I have again perceived these singular manifestations, in a 
pamphlet, otherwise interesting, of M. Lafont Gouzy fils. 

But here some serious objections present themselves. '" The 
existence of chancre in the urethra cannot explain all the cases 
of constitutional syphilis, which appear to have blennorrhagia 
as a point of departure.'' "The number of urethral chancres 
is too small relatively* to that of the constitutional veroles with 
blennorrhagia as antecedent. In fine, there are some cases of 
blennorrhagia in which it has been impossible to verify the 
urethral chancre, and which have been followed by constitu^ 
tional accidents." 

Here I am going to astonish greatly my antagonists by ma- 
king the concession that all this is true. But you will see, dear 
friend, that this concession is but apparent ; for I hasten to add, 
that which ceases to be true are the explanations which have 
been given of these facts. 

It is very certain that relatively to the immense number of 
blennorrhagias which exist, the symptomatic blennorrhagia of 
concealed chancre in the urethra constitutes the exception. In 
fact, they say to me, with an appearance of reason, but how 
is it, then, that the number of cases of syphilis coming on after 
the pretended chancre of the urethra, should be almost in pro- 
portion with the veroles coming on after the external chancre ? 
Here, my dear friend, I ask all your attention, not because I 
wish to be subtile or captious, but because the form of reason- 
ing which I am forced to employ to answer this objection, itself 
very subtile and captious, has need of being followed in all its 

Yes, the chancre concealed in the urethra is rare. 

1853.] RicoroVs Letters on Syphilis. 107 

No, the number of veroles, the consequence of chancre con- 
cealed in the urethral does not appear rare. 

You are about to cry out, sophistry ; bul hear me. 

That chancre in the urethra is rare, is incontestable ? my 
experiments, those of my honorable colleague and friend, M. 
Puche, and those of many other observers, have proved it 

without reply. \)o you wish 'ha! I establish a proportion? I 
much desire to do so. Let us admit I in 1.000, which is, I am 
convinced, far greater than the reality. Let there be, then, on 
one hand, 1 chancre of the urethra, in 1000 cases of bJennor- 
rbagia. Do you recollect on the other hand, how frequent and 
extended is blennorrhagia ? Do you recollect that Lislranc, 
with perhaps a little exaggeration, said that out of 1,000 adults, 
he counted 800 who had had. who had then, or would have blen- 
norrhagia ? However this may be. my dear friend, out of 1,000 
of blennorrhagia, there are 91)9 of which you never hear 
mention, which will have had no unhappy consequences, 
against a solitary one, which will have determined the consti- 
tutional infection. 

It is a small number, without doubt, but make your calcula- 
tions upon the hundreds of thousands, upon entire populations, 
upon the population of Paris, for example, which numbers 
three to four hundred thousand adult men ; compute the num- 
ber of blennorrheas contracted in this great city ; only cal- 
culate for the concealed chancre but the small number of 1 out 
of 1.000, and you will stdl arrive at a sufficiently large number 
of blennorrhagias which would consecutiveJy determine the 

Well, what happens in practice ? That you do not see in 
the hospitals nor at the consultations of physicians, but those 
patients in whom the syphilitic infection has been preceded by 
a blennorrhagia with a concealed chancre. A physician of a 
hospital devoted to these diseases, could meet, in the course of 
his practice, with ten, twenty, thirty examples; but what is 
that in comparison to the number of simple cases without anv 
unhappy consequences ? But those patients who have no oilier 
antecedent than the blennorrhagia for I heir constitutional infec- 
tion, strike the mind of observers ; the remembrance o\ them 
remains deeply engraved ; their number, relatively small, in- 
i their imagination, and they do not fail to pre 
• rmidable objection to the non-identity of blennorrha- 
gia and syphilis. 

You see to what this objection is reduced ; I hope that I have 
destroyed it. 1 am accused of founding an \i] - with 

the concealed chancre, of estal lishing a system. However, 1 
have proved the fact of its existence by pathological anatomy. 

108 Ricord's Letters on Syphilis. [February, 

I have deduced it also from my experiments with inoculation. 
Is it not true that blennorrhagia in the immense majority of 
cases is exempt from every consequence of syphilis? To what, 
then, can we attiibule the infection when it comes on after 
blennorrhagia ? J myself attribute it to concealed chancre ! and 
my adversaries — to what do they attribute it? To a pretend- 
ed identity, which the observation of every day, and great 
abundance of facts, incessantly contradict. And it is I whom 
they accuse of being systematic, I who elevate a doctrine upon 
the basis of observation, of experimentation and of pathological 
anatomy. What, then, are mv adversaries, who, for the sole 
support of their doctrine, invoke but a rude fact, the interpre- 
tation of which does not repose upon any of the elements ne- 
cessary at the present day tor the demands of science! 

Believe, then, dear friend, that it is my adversaries who 
launch themselves into the way of hypothesis, whilst I, on the 
contrary, strive to bring them back into the path of reality. 
You see now that it is easy to conciliate these two terms of my 

Yes, the chancre concealed in the urethra is rare; but the 
number of veroles, the consequence of chancre concealed in 
the urethra, does not appear small. It does not appear small, 
because we see again only those patients who have been suffer- 
ing from this concealed chancre; but if a strict proportion 
could be established between the cases of blennorrhagia not fol- 
lowed by syphilitic accidents, and those which have given 
place to them, we should see that the last are proportionally 
very rare, and that this appearance of frequency is entirely 

But in other respects, in all the cases in which the constitu- 
tional verole has been referred to blennorrhagia, have all possi- 
ble precautions been taken in order not to be led into error ? I 
do not believe it, when I see that some are contented with a 
diagnosis offered by the patient, and w 7 ith his own history. We 
could truly say that the physician has in some way declined 
his jurisdiction. You will see some striking examples of this 
confidence of the physician in the story of his patient, in the 
works of MM. Martins, Cazenave, and in the thesis, in other 
respects so w ? eli written, of M. Legendre. 

How many causes of error there are in the stories of pa- 
tients! Blennorrhagia is ordinarily a very painful and annoying 
accident, and one which leaves behind some smarting recollec- 
tions to those who have had it. When you interrogate patients 
upon their previous history, it is always of their blennorrhagia 
that thev first speak; they do not suspect the importance that 
the chancre can have, which, while it infects, is ordinarily 

1853.] RicoriPs Letters on SyphiHs. 109 

indolent, suppurates but little, has little tendency to extend, 
and often cicatrizes of Its own accord : it is rare that they make 
mention of this accident, and if by a pressing inquiry you cause 
them to bring the circumstance to mind, they will tell you that 
it was a superficial chancre, a sim iation. I am allow- 

ed to call to mind, that it is only since my works, that the 
manner of considering blennorrhagia as regards the accidents 
of constitutional syphilis, has been a little more strict. In fol- 
lowing the course which 1 have marked out, we are forcibly 
brought to confi ss that the great number of urethral blennorrha- 
- which do not furnish inoculable pus, were not followed by 
constitutional accidents. 

Among other statistics advanced, 1 shall cite the most recent, 

those made last year by M. Lafont Gouzy, who. out of 380 

< o\ urethritis inoculated, found hut two cases in which the 

inoculation gave any results. One of the two presented, four 

months later, symptoms of constitutional syphilis. 

In this work of M. Lafont Gouzy, he has mentioned two 
cases in which the inoculation gave no result, and which were, 
however, followed by syphilitic accidents. We shall have oc- 
n later to explain these exceptional ca 
M. Baumes cites five examples of individuals affected by 
simple blennorrhagias, in which the constitutional infection is 
nevertheless seen to appear at a later period. From these 
facts our honorable colleague draws an argument in conclusion, 
that the blennorrhagia non-symptomatic of chancre, can, like 
the chancre, produce the syphilitic infection.* 

But, first, are all the veroles which have been attributed to 
blennorrhagia really the consequence of it? If we did not 
take care of the manner in which statistics were made, we 
should find, as M. Cazenave and others have, that blennorrha- 
gia is the most frequent antecedent of the constitutional verole, 
because it is really rare to find individuals who have not had 
one or more attacks of blennorrhagia. But, when knowing 
the value of the chancre as a necessary antecedent, we seek 
what its frequence is, even among the authors where its valua- 
tion leaves so much to desire, we find, in the statistics of M. 
'nave, for example, that out of 12 observations, blennorrha- 
existed, alone or with buboes, but 18 times, while chancre 
occurs 38 times. From which M, Cazenave concludes, very 
logically, as you see, that blennorrhagia is the most frequent 
antecedent of syphilis. The same results from the sumn 
up of the observations of M. Legendre, and the same logical 
conclusion folio/ 

* One of the five patients of M. Baumes had a chancre previously ; it is, then. 
to this chancre that the verole of this patient must be referred. 

110 Ricord's Letters on Syphilis, [February, 

It remains established for science, and in my opinion, that 
from the statistics of my antagonists even, the chancre visible 
and avowed by the patient, is still the most frequent antece- 
dent of syphilis. My wards of the Hospital du Midi enclose at 
this moment 01 cases of well-marked constitutional syphilis; 
all, without exception, have had chancre as precedent. 

Now, in cases where we cannot go back to the pre-existence 
of a chancre, neither by the recollections of the patient nor by 
interrogation, what reason is there to deny absolutely the pre- 
existence of an urethral chancre ? You see, then, what we 
should think of the opinion of M. Cazenave, expressed in these 
terms, " Far from blennorrhagia never giving place to seconda- 
ry symptoms, it would appear, on the contrary, to determine 
them more frequently than the chancre.'"' 

You know, dear friend, for it is in your own Journal, that this 
opinion of M. Cazenave has been warmly approved. M. Yidal 
(de Cassis) has expressed his sentiments for M. Cazenave in 
the following manner, which he says is not an academic au- 
thority, but which has the advantage of being an authority 
quite special. 

'•We know what the position of M. Cazenave is, the vast 
theatre upon which he makes his observations, his taste for sta- 
tistics, for all thejneans, in fact, which, according to my adver- 
saries, conduct to certainty. Well, M. Cazenave has succeed- 
ed in establishing that the symptom of which the virulence is 
rarely affirmed before experimentation, is exactly the symptom 
most virulent, the most infectious, according to observation." 

It is true that to prevent M. Cazenave from being too much 
in a hurry to felicitate himself upon this warm approbation, M. 
Yidal hastens to add, on the following page : 

"However, I do not dare to go as far as M. Cazenave, who, 
according to my ideas, puts too many syphilitic eruptions to the 
account of blennorrhagia. Blennorrhagia, in my opinion, is an 
affection much more contagious than infectious.'' 

That is just my idea, Monsieur Yidal, as you are well aware; 
only permit me to express my astonishment that it is yours, 
you who believe that M. Cazenave has succeeded in establish- 
ing the contrary. I do not wish to insist longer upon this 
flagrant contradiction, which is, after all, perhaps, but a criti- 
cism of conciliation. 

As to the cases of blennorrhagia of which the inoculated 
muco-pus has not given any results, and which have been fol- 
lowed by a general infection, the observations which have been 
reported of them leave much to he desired, and are, I ask par- 
don of my learned brother of Lyons, to be received with excep- 
tions. The astonishing credulity, the truly blind confidence of 


1853.] RiconPs Letters on St/philis. Ill 

some physicians, although rendering their works very respect- 
able, are far from carrying conviction into all minds. In 
particular cases I do not wish to spare the symptomatolo- 
gy of constitutional accidents, which is incomplete, relatively 

to some important points, upon which I shall desire to return; 
I wish, also, that in these cases, constitutional syphilis should 
really be the subject of inquiry. 

I admit that the appearance of these syphilitic accidents 
agrees; as regards the period, with the time in which blennor- 
rhagia is developed ; but are we very sure from this fact alone 
that the patients have had nothing but blennorrhagia — that 
syphilis could not have penetrated by another way? My bro- 
ther physician at Lyons has somewhere said that J denied the 
possibility of a constitutional syphilitic infection from a simple 
blennorrhagia, because I had never seen an example of it. It 
is, on the contrary, because I have seen many patients in whom 
physicians, who do not think as I do, have recognized but a 
simple blennorrhagia, where I have found another door for the 
entrance of syphilis, that my convictions have become more 
and more profound. When those who maintain that a simple 
blennorrhagia should give place to the verole, have told you 
that the patienl presented no ulcerations, either upon the geni- 
tal organs or upon the lingers, they think they have nothing 
more to exact. They forget the instances without number that 
the surface of the body presents secret, concealed doors, which 
close as soon as they are opened, so that the patients are igno- 
rant, or it is for their interest to conceal their knowledge. How 
many students have come to me from the other hospitals of 
Paris, in whom nothing but a blennorrhagia has been proved, 
and in whom I have found chancres in unusual places. While 
upon this subject, here is a story, analogous to many in my 

A lady came to consult me for a disease of the rectum, the 
symptoms of which, she complained, were those of a fissure. 
Upon examination I found absolutely nothing about the anus. 
But the finger introduced into the intestine, discovered, at the 
height of the superior sphincter, a fissure situated upon the 
anterior portion and reposing upon a callous suiface. I pro- 
posed an operation; the patient refused, and 1 ordered her en- 
emas of rhatania. This treatment had scarcely lasted fifteen 
days, when in another visit I perceived an exanthematic erup- 
tion, having all the characteristics of a confluent syphilitic 
■la. Upon farther examination I recognized the swelling 
of the posterior cervical ganglions. The ; atienl suffered from 
nocturnal cephalalgia, and already scabs commenced to devel- 
ope themselves upon the scalp. To me there could be no 

112 Contraction of the Knee. [February, 

farther doubt upon the nature of the accidents. I then exam- 
ided the genital organs ; but I could only perceive a slight 
uterine catarrh. Interrogated upon the conditions in which 
this lady could have been placed as regards the contagion of 
syphilis, she confessed that her husband was diseased, that he 
had ulcerations on the penis, and that in the fear of communi- 
cating them to her, he had had relations with her a prep outer & 
venere. Thus the nature of the fissure was unveiled to me. 

Jn this case is it not true, that without the painful accidents 
brought on by the fissure, this ulceration would have passed 
unperceived ? It would have then happened that we should 
have had for the sole antecedent of syphilis, a simple uterine 
catarrh. But there exists still other causes of error which I 
wish to point out to you. This will be the subject of my next 
letter. Yours, &c. Ricord. 

[ To be continued.] 

On Contraction of the Knee-joint. By John Watson, M. D., 
of New York. 

Dear Sir, — The object of the present communication is to 
direct your attention to the extension pulleys as a means for 
overcoming contraction and anchylosis of the knee, and to 
suggest the propriety of the same apparatus in the treatment 
of permanent contraction and rigidity at the hip-joint, as well, 
perhaps, as for breaking up the temporary callus in badly uni- 
ted fractures. 

Among the mechanical contrivances now in use for this 
purpose, as applied to the knee, are — first, the screw clamp, 
which is secured to the limb in the neighborhood of the affect- 
ed joint, in such a way as to straighten it, by what has been 
aptly called the crushing process. Secondly, splints and rol- 
lers, also applied in the neighborhood of the joint, with the 
view of straightening it gradually: and again, in cases of long 
standing and perfect consolidation of the joint, the excision of 
a prismoid section of bone, either from the opposing portions 
of the tibia and femur, or from the shaft of the latter just above 
the joint. It remains to be proved how far the extension and 
counter-extension apparatus, adjusted to the ankle and perine- 
um, may be advantageously introduced as a substitute for less 
certain or more hazardous mode of treatment. 

The application of the clamp, though recommended and oc- 
casionally employed in Europe, has not met with much favor 
here. The force being employed directly over the joint by this 
apparatus, to be effectual in many cases of long standing, must 
be such as to inflict severe injury on the soft parts : and the 

1853.] Contraction of the K 113 

lurgeon, not having the entire menus of regulating the d< 
of pressure requisite', may carry this to such an extent as to 
crush the cancellated structure of the condyles, or injure the 
s and blood vessels in the vicinity of the joint. Splints 
and rollers, to be of any service, must be of long cootinui 
and when at last they appear to be iu - ree bucc< 

the limb is drawn down bymak »nd crook in the upper 

pari <>f the shaft of the tibia, rather than by any yielding at the 
joint itself. The consequence of this is, that the limb loses 
considerably in length by making this double curve; and even 
when straightened, the leg is thrown at some distance behind 
the proper axis of the lemur. The excision of a prismoi I 
tion of bone from the front of the joint, is an operation applica- 
ble only to the severest cases of confirmed bony consolidation ; 
and though occasionally attended with admirable results, is one 
of great severity and much hazard, and, as already proved by 
experience, liable to fatal consequences. 

1 have taken no pains to inquire upon what authority the 
extending and counter-extending straps and pulleys may have 
heretofore been suggested or recommended in such cases, nor 
am I aware that they have for ihis purpose been ever before 
employed. But in the following case, this mode of drawing 
down the contracted limb was entirely succesful; and I am 
disposed to think that it should hereafter always he borne in 
mind, as one of the expedients to which the surgeon should re- 
sort, before attempting more painful or dangerous proceedings. 

Peter Fred, a German seaman, aged 23, was admitted into 
the New York Hospital, on the 16th of June, 1852, with his 
left knee (lexed nearly at a right angle, and so rigid as not to 
yield in the hast to any force I could apply to it by my own 
unaided muscular strength. The contracted joint was free 
from pain, and of the same temperature as the rest of the limb. 
The patella was firmly glued to the side of the inner condyle 
union. The rigidity and contraction had exited 
sixteen months, and had followed a sub-acute attack of rheu- 
matism, or synovitis, the result of exposure to wet weather in 
California. The patient, inoth cts a healthy man, had 

been under treatment at an hospital in San Francisco for sev- 
eral months, and subjected to repeated blistering, cuppii g, and 
other me ocal and general, without advantage. 

( >o the 19th of June, with the patient on his back and ui 
the lull anaesthetic influence of sulphuric ether, with a counter- 
extending strap to make traction from the perineum, and with 
the extending bai e the anl 

had the force of the pulleys applied to the limb, as in luxations 
of the hip-joint, keeping my hands around the joint, tojud. 

114 Contraction of the Knee, [February, 

feeling of the amount of yielding, and to thus regulate the force 
of extension necessary for straightening the limb. 

As the extending cords became tense, I could feel, and even 
hear, the adventitious adhesions gradually giving way, until, at 
length, the patella sprang loose from its attachment to the con- 
dyle, and the diseased limb was drawn out as straight as the 
other. On loosening the apparatus, I now found I could flex 
and extend the joint as freely as if it had never been the seat of 
diseased action. 

After the operation the limb was adjusted in the straight 
apparatus, as usually employed for fractures of the thigh ; a full 
anodyne was administered, and an evaporating lotion applied 
to the knee, to guard against the occurrence of excessive in- 
flammation. For the first twenty-four hours after the straight- 
ening of the limb, the patient suffered considerable pain in the 
joint; but the ensuing inflammation was slight; and on the 2d 
of July it had so far subsided as to admit of passive motion. 
The patient soon afterwards began to move about the ward, 
with a stiff splint secured behind the knee, to prevent any re- 
newed tendency to contraction. On the 29th of July, he was 
walking about the yard with the aid of a staff; the joint, how- 
ever, still tender. He remained under observation, using daily 
embrocations to the joint, and wearing his splint behind the 
popliteal space, until the 6th of September, at which date he 
was discharged, with his limb in a position which enabled him 
to walk with a slight halt, but with some remaining rigidity 
and tenderness, though with no further apparent tendency to 

A point of much importance in all cases similai to the fore- 
going, is to determine the time at which the sudden straighten- 
ing may be attempted with most advantage. While the disease 
is still acute, and the contraction merely muscular, the limb 
may be managed by ordinary splints for favoring the straight 
or, at most, a very slightly flexed position; and, in the sub- 
acute or chronic state, so long as inflammation persists, any 
effort at sudden straightening is likely to be followed with a 
renewal of acute inflammation, and the recurrence of the con- 
traction to as great an extent as ever. The rule, then, shonld 
be to wait until the inflammation has wholly subsided, a fact 
readily determined by the subsidence of pain, but more conclu- 
sively by finding the integuments in the neighborhood of the 
affected joint of no greater temperature than the surface of the 
skin in other parts of the limb. 

An instance somewhat analagous to the foregoing, in which 
both knees were affected, but in which the rigidity was still 
confined to the fibrous and other softer tissues around the joints, 

1853.] Contraction of the Ki 11 

occurred to me a few years since, and forcibly illustrates the 
truth of the remark just made, in reference to the proper time 
for resorting to forcible extension. The patient was a young 

man of 'J'-i or 23 years of age. The contraction, in this 
also, was the result of a sub-acute attack of rheumatism. The 
limbs were SO drawn np, (hat the heels were almost made to 
strike against the nates. The rheumatism in the right knee had 
entirely disappeared, hut in the left there were still some slight 
remains of the inflammatory process. The contraction and 
rigidity of the joints had existed six or eighl weeks. Finding 
the right knee not absolutely anchylosed, I at once resolved 
upon straightening it suddenly: and this 1 effected in an hour 
or so. after exj ending the whole of my muscular force upon it. 
The limb, once brought down, was secured in the straight po- 
sition for a week or ten days, after which the disposition to 
contraction disappeared, and the joint was restored to its heal- 
thy functions. Having thus succeeded with the right,] resort- 
ed to the same procedure for the left knee : and after still more 
protracted efforts, I also succeeded in bringing this limb into the 
straight position. Hut the o| eration was an exceedingly pain- 
ful one. The inflammation returned with greater violence 
than at first ; the patient afterwards entered the medical wards 
of the hospital, where, notwithstanding every effort to keep the 
joint straight, it ultimately contracted so a- to be of little use 
to him in walking, and afterwards continued so. 

It is remarkable how slight a degree of inflammation in and 
about the joints may now and then give rise to the most obsti- 
nate tendency to contraction. Many instances, if necessary,. 
I could enumerate in proof of this remark. One of the severest 
of these was that of a young man, who, after an attack of 
rheumatism, lost the use of almost every joint in his body, 
large and small, even to those of his fingers and toes, so that 
lie lay for years bed-ridden, and drawn up into a sort of ball. 
Another instance was that of an elderly lady, who, in conse- 
quence of rheumatism, had both elbows permanently fl 
and anchylosed. I hive at present under observation a 
tleman suffering from anchylosis of his right elbow, resulting 
from the same cause : and a young lady of 17 years of age, in 
whose case, without any real deformity of the spine, most of 
the dorsal vertebrae have become consolidated; the patient, in 
the meanwhile, free from pain, an ! not conscious of ever hav- 
ing at any time suffered from active inflammation in any por- 
tion of the spinal column. Blows and punctures often lead to 
similar contractions; and where these occur in early life, de- 
priving the limb of its freedom of motion, they lead to arn 
development. One instance of this sort, in which the right 

116 Contraction of the Knee. [February, 

arm has ceased to grow in keeping with the left, I have re- 
cently witnessed in a young man, who, many years since, fell 
upon his elbow, and has ever since been troubled with a rigid 
and contracted joint, now firmly consolidated by bony deposits. 

The well-known case of anchylosis of the hip, upon which 
the late Dr. J. K. Rodgers operated for producing an artificial 
joint, came on without any sensible injury of the part, and 
without any evidences of inflammation, while the patient was 
confined to bed in the New York Hospital, and under treat- 
ment for a fracture of the opposite limb. Now, in this case, 
even as soon as the anchylosis was first detected, mere manipu- 
lations with the hand were unable to overcome it. But had 
the extension pulleys been applied, there is reason to believe 
that the limb might have been restored to usefulness. The 
operation of exsection of bone, which was resorted to as the 
only efficient means of treatment then devised, might thus 
have been wholly obviated. The patient, though in the utmost 
jeopardy for many days after the operation, ultimately recov- 
ered, gaining little, however, by the operation ; for the artificial 
joint soon afterwards consolidated. But in a more recent case, 
in which the same operation was employed, the result was dis- 
astrous. It is not probable, however, that in this latter case, 
where the anchylosis was of many years' duration, the exten- 
sion pulleys would have proved available. The use of these 
for anchylosis at the hip, would, apriori, appear to be safe only 
while callus is yet nascent, and before the consolidation has 
become so firm as to jeopardize the bony structure of the 
acetabulum in attempting to overcome it. 

The pulleys may also be substituted, with advantage, for the 
more common mode of breaking up the recent callus in badly 
united fractures. It has been shown by Dupuytren, that the 
formation of the permanent callus after fractures, is completed 
only after an interval of many months ; and yet after an inter- 
val of three weeks, I have known the temporary callus in a 
badly united fracture of the thigh, so very firm as to resist the 
best directed efforts to break it up by mere lateral force. I 
remember to have once assisted my friend and former colleague, 
Dr. Hoffman, in overcoming a similar deformity after fracture 
of the leg. In this instance, after etherizing the patient, the 
rigidity was overcome by the union of direct pressure over the 
seat of accident with extension at the heel. The pulleys, how- 
ever, would probably have been an easier and more expeditious 
mode of management. 

Surgery, as well as medicine, has its fashions ; and while we 
are ready to apply the extension pulleys to new uses, we are 
learning to dispense with them in some of the very accidents 

1853.] Bright' s Disease. 117 

for the cure of which they were originally introduced. Our 
celebrated countryman, Nathan Smith, about the commence- 
ment of the present century, as I learn from one of his early 
pupils, Dr. Bat chelder, of this city, as well as from the memoin 
of him prepared by his son. Dr. N. R. Smith — was in the habit 
of pointing out to his students a method of reducing luxations 
of the femur on the dorsum of the ilium by merely flexing, ad- 
ducting or abducting, and rotating, the thigh upon the pelvis. 
Others, both in this country and Europe, have since the time 
of Nathan Smith, been accidentally successful in a few similar 
cases. In Germany, since 1823, the subject has been more 
carefully studied and systematized by Colombat, Wattmann, 
Kluge and Rust ; and in our own State, within the pasi year, 
by Dr. W. W. Reid, of Rochester, whose process, as described 
in the last volume of the Transactions of the New York State 
Medical Society, is nearly identical with that of the latter 
writer. I am happy to say that the attention which Dr. Reid 
has anew attracted to this subject, is likely to make the flexing, 
adducting, abducting and rotating process, the general mode 
of treatment in all recent luxations of the head of the femur 
backwards; and that, at the New York Hospital, two, if not 
three cases have already been reduced, without the aid of pul- 
leys, by this method. — \_j\ew York Medical Times. 

On Brighfs Disease, and its Connection with Puerperal Con- 
vulsions. By Dr. Litzmann, (Deutsche Klinik.) 

Prof. Litzmann, of Kiel, has published an elaborate memoir 
on renal disorder in pregnant and puei peral females. He com- 
mences by describing twelve cases in which albuminuria and 
oedema were present ; some of the women had convulsions. 
Three of the patients were pregnant with twins; and nine 
(including the twin cases) were pri mi parse. 

In several of the cases, especially where convulsions were 
present, or were threatened, or where there were symptoms of 
mia, as amaurosis, etc., cai Donate of ammonia was discov- 
ered in the blood and in the air expired from the lungs, and in 
the blood of the children who were bom dead. This was in 
accordance with the view of Dr. Frerichs, that urea, when ac- 
cumulated in the blood, becomes converted into carbonate of 
ammonia, and then produces toxemic symptoms. 

Including the twelve cases described, Dr. Litzmann has ex- 
amined the urine of 131 persons; 79 during pregnancv, 80 
during labor, and 80 after parturition. In these he has found 
albumen present in 37, and absent in 95. The examinations 

n. s. — VOL. IX. NO. II. 8 

118 Bright 's Disease. [February, 

began, with few exceptions, in the last three months of preg- 
nancy ; in almost all cases they were repeated several times, 
and in several daily ; yet it is possible that small quantities of 
albumen may have escaped notice. In order to avoid the ad- 
mixture of foreign matters from the vagina, the catheter was 
used always with parturient women and those who had been 
delivered, and frequently in pregnant females. In the latter, 
as well as in those who had been confined, the urine passed in 
the morning was employed. Heat, and acetic, or nitric acid, 
were the tests used. 

Of the 95 females, whose urine contained no albumen, 53 
primiparae and 42 multiparas. Of the 37, who had albuminu- 
ria, 26 were primiparae and 11 multiparas; among the latter 
was one who had albuminuria in her first pregnancy, and two 
who were pregnant with twins. 

Among the 37 females, the urine of 16 was discovered to be 
albuminous during pregnancy. In ten of these the albuminuria 
continued during labor, and for some days afterwards ; in four, 
where it was less intense, it disappeared before confinement ; 
and in two cases, circumstances prevented the examination 
from being continued. 

In four women who had been confined, and whose urine 
contained albumen, no examination had been made during 
pregnancy. There can be no doubt, however, from the quan- 
tity of albumen found, and the other symptoms, that it had 
been present. 

In four females, in whose urine no albumen had been found 
during pregnancy, albuminuria appeared during labor — in two 
evidently for the first time. 

In ten persons, in whose urine no albumen had been present 
during pregnancy, there was considerable albuminuria after 
delivery. In eight of these, the urine, examined during labor, 
was found to contain no albumen. 

In three females who had been confined, and in whose urine 
albumen was found, no previous examination had been made. 

There is a form of albuminuria unconnected with renal dis- 
ease, but arising from catarrhal irritation or blennorrhea of 
the bladder. Dr. Litzmann has observed it twice during preg- 
nancy, several times during labor, but most frequently after 
delivery. It generally appears on the second or third day, and 
goes on increasing till the sixth or seventh. The quantity of 
albumen is not great, and is connected with the presence of 
purulent mucus. At first, the urine after delivery is high-color- 
ed, of acid reaction, -and contains a large quantity of urates 
and uric acid, with epithelium and a number of pus or mucous 
globules. It afterwards becomes lighter and yellow in color, 

1853.*| Brian's Disease. 119 

slightly turbid, contains less urates, and is less acid ; on long 
standing, it deposits a sediment of pus corpuscles with more 
or less epithelium. Fibrinous casts of the urinif'erous tubes are 
never present. In only two cases was the quantity of pus in 
the urine sufficient to be detected by the naked eye: these 
were more chronic than most of the others, recovery not being 
effected till the eighth week. 

In both these cases, which Dr. Litzmaim relates, there had 
been, during labor, longoontinued pressure on the urethra and 
neck of the bladder; and this may have acted as the proxim- 
ate cause of the disease. Vet cases very often occur, in which 
me causes do not produce such effects. In most of the 
women affected with vesical catarrh after delivery, the disi ase 
could not be attributed to the above cause, the labors having 
been regular, and even easy. Dr. Litzmann is inclined to be- 
Neve that slight vesical catarrh, which may not cause albumen 
to be present in the urine, but which may furnish a sufficient 
quantity of pus or mucous corpuscles to be detected with the 
microscope, is of not un frequent occurrence after deliver v. 
During and before labor the disorder is much more rare. 
When it occurred during labor, this had almost always been 
tedious, without, however, in general producing retention of 
urine. One of the pregnant females who were affected had 
^. and was at the same time seized with rheumatic swell- 
ing of the hands. In another, the vesical catarrh was brought 
on in the fourth month of pregnancy, by retroversion of the 
uterus. The local symptoms were generally very slight; on 
being questioned, the patients would acknowledge a little un- 
easiness or sense of heat in the bladder: but the state of the 
urine was generally the only diagnostic symptom. Of the 37 
cases of albuminuria which Dr. Litzmann observed, he believes 
that half were referrible to catarrh of the bladder: this \, 
certained in nine of the cases, by microscopic examination. 

Simple albuminuria, and B right's disease, (albuminuria ac- 
companied by fibrinous exudation into t tie uriniferous tubes), 
gradually into each other in pregnant females. In most 
ot the cases in which albuminuria had reached a high degree, 
fibrinous east- were found towards the end of pregnancy, or 
during labor and the early part of the subsequent period." Of 
the 3*3 f albuminuria. Dr. Litzmann found 13 to be con. 

nected with Bright 'a disease: in 7, fibrinous casta were found: 
in one. the urine could only be examined once, and, though not 
then found, they were probably present: and in five, there 
could be little doubt from the quantity of albumen and the con- 
comitant symptom- — i in three cas.< — that thev were 
present, although the urine was not examined microscopically. 

120 BrigMs Disease. [February, 

There can be no doubt that, as has already been pointed out 
by Rayer, the albuminuria of pregnant females arises from a 
mechanical obstruction to the renal circulation. From the ex- 
periments of Frerichs, it appears that the retardation of the 
venous circulation on the kidneys easily produces exudation of 
albumen and fibrin, and finally, even of blood. On the other 
hand, increased arterial impulse, as from ligature of the aorta 
below the renal arteries, only rarely gives rise to slight albumi- 
nuria; and it is when one kidney is extirpated at the same 
time with the ligature of the aorta, that any notable quantity 
of albumen appears in the urine. In favor of the mechanical 
view of the explanation of albuminuria in pregnant women, 
may be adduced its predominance in primiparae — a fact recog- 
nized by all observers. The tight and unyielding abdominal 
wall must naturally cause the uterus to press more strongly on 
the organs lying behind and above it. It is moreover probable 
that when albuminuria has occurred in multiparae, it has been 
but a repetition of the same affection which they had as prim- 

In many of the cases, there were also other causes which 
tended to increase the pressure. Five of Dr. Litzmann's pa- 
tients, who had albuminuria, were pregnant with twins ; in 
others, there was a large quantity of liquor amnii, or a large 
child, or both ; in one case, there were periodical contractions 
of the muscles, especially of the recti, pressing the uterus against 
the spinal column ; in four cases, the pelvis was narrow. Three 
of the patients had chronic pulmonary catarrh. It cannot, 
however, be denied, that cases are often met with, in which all 
these circumstances are present without producing albuminu- 
ria ; and, on the other hand, that albuminuria sometimes oc- 
curs, even in a high degree, without more than ordinary pres- 
sure being apparently exerted. An additional ground for 
assuming the dependence of albuminuria in pregnant women 
on mechanical impediment to the circulation, is found in the 
rapidity with which it disappears as soon as, by emptying 
the uterus, the free circulation of the blood has been re-estab- 

Besides the mechanical cause, we must take into account the 
state of the blood in pregnant women (increase of water and 
fibrin, decrease of albumen, diminution of the red, and increase 
of the colorless particles). Most of the pregnant women with 
albuminuria, observed by Dr. Litzmann, had a more or less 
chlorotic appearance ; while others appeared fresh and healthy. 
The state of the blood did not appear sufficient to cause albu- 
minuria, without an impediment to the circulation of the kid- 
neys. In common with Lever, Devilliers and Regnault, etc., 

1853.] Intussusception of the Bowels. 121 

Dr. Litzmann has not been able to recognize cold or tbe abuse 
of spirituous liquors, etc., as the cause of albuminuria in preg- 
nant females — [London Jour. Med. 

Intussusception of the Bowels. By Daniel Barber, M. D., 
of New Richmond, Ohio. 

Gentlemen- — Believing that the following plan of treating 
intussusception of the bowels is not familiar to the minds of 
many of the profession, I submit to you a case in which it was 
successfully applied. 

The subject was a young man aged twenty years. lie had 
two attacks of colic within ten days. Consiipation followed 
immediately upon the last. He was treated for four days with 
purgatives — warm water injections — bleeding, &c, without 
any effect. At the end of this time (Nov. 13) I was called in 
consultation with Dr. Bennett, of Withamsville, the attending 
physician. I found the case as follows: Pulse 120, abdomen 
tympanitic, and tender to the touch, extremely severe parox- 
ysmal pain of the bowels, frequent vomiting of highly offensive 
matter, obstinate constipation. 

To subdue the tendency to peritoneal inflammation, we re- 
peated the bleeding and administered the sulphate of morphine, 
in half grain doses every two hours until he was brought fully 
under its influence. When I returned on the evening of the 
14th, the pulse had fallen to 96 — the tenderness and pain of the 
bowels were materially diminished — the vomiting less frequent 
and distressing — constipation continued. Frequent and large 
quantities of warm water has been continued to be injected. 
At my suggestion the following plan of treatment was now 

We procured a small quantity of brewer's yeast, from which 
was prepared in the usual way a quantity sufficient for our 
purposes. At about midnight, we gave a tumbler half full, and 
ordered the same quantity to be repeated once or twice every 

On the afternoon of the 15th, when it was obvious from the 
quantity taken and retained, that the intestines above the ob- 
struction, were distended with carbonic acid gas, the colon 
was likewise inflated with atmosphere by means of a pair of fire 

By these means combined, the intestinal earn! throughout its 
whole course \\ is inflated, and the obstruction reduced. 

At nine rening, a copious evacuation of the 

bowels ensued, followed by several others during the night. 
At the same time the explosions of gas were so violent as to be 

122 Syrup of Assafetida. [February, 

heard at some distance from the house — it was literally keeping 
up a regular fire. The patient was at once relieved, and speed- 
ily recovered his former health. Besides the distending force 
of the gas, it is very probable that it exercises a beneficial 
influence by its sedative and antiseptic properties. 

I believe this practice originated with the French, but to 
what extent it has been applied I know not. Dr. Johnston and 
Rogers, of this place, have given yeast in two or three cases of 
this disease during the course of their practice here, with suc- 
cess. In one case relief was afforded on the fourteenth day of 
the attack, after every other means had been tried and failed. 

From the above facts I should feel disposed to give this plan 
a trial in every case, where the ordinary means fail. Should 
relief not be obtained in a reasonable length of time, and the 
case be protracted, and as it w 7 ere hopeless, a moderate exhibi- 
tion of the yeast, by its antiseptic properties and by gently 
exciting the peristaltic action, would afford perhaps the best 
prospects of success. — [Western Lancet. 

On Syrup of Assafetida. By Richard Peltz. — (From an In- 
augural Essay.) 

Assafetida has long held a high rank as an antispasmodic and 
expectorant, but has not been used as extensively as its virtues 
seem to demand, both on account of its very unpleasant odor 
and acrid bitter taste. It consists chiefly of resin, gum and 
volatile oil. 

The Pharmacopoeia of the United States recognises as offi- 
cinal two fluid preparations of assafetida — the tincture and the 
mixture. These, although very good preparations, are both 
objectionable on account of their unpleasant taste. This, I 
think, could be remedied in part by making a syrup: with 
which purpose I have undertaken a number of experiments, to 
ascertain if a preparation could not be made which would con- 
tain in a more agreeable form all the medicinal properties of 
assafetida soluble in water. 

Having tried a number of methods I concluded that the follow- 
ing formula would make the most perfect preparation ; Take of 
assafetida, an ounce ; boiling water, a pint; sugar, two pounds. 
Triturate the assafetida in a mortar with a portion of the boil- 
ing water until a uniform paste is formed, then gradually add 
the remainder of the water, strain and add the sugar, applying 
a gentle heat to dissolve it. 

Much heat should be avoided in forming the syrup, as the 
volatile oil. which is present in considerable proportion in good 
assafetida, (nearly 6 per cent.,) a portion of w T hich is dissolved 
or held in suspension by the water, would be dissipated. 

1853.] Glycerin Ointment 123 

There is an advantage in using boiling water, as it takes up 
more of the gum-resin, which is permanently dissolved or held 
in suspension by the sugar. 

This syrup, when first made, is nearly white, but upon expo- 
sure to light gradually assumes a pinkish tinge. It is of the 
same strength as Mixture of Assafetida of the Pharmacopoeia, 
and owing to its being more pleasant to the taste, might with 
advantage be given as a substitute for that preparation, espe- 
cially in cases of children, as the sugar conceals much of the 
unpleasant acrid taste of the assafetida. 

This syrup is much more permanent than the mixture, hav- 
ing kept some for several months without any apparent change, 
except in color, owing to the action of the light on the resin; 
while the mixture kept in the same situation became very un- 
pleasant in a short time. It also has an advantage over the 
tincture in being entirely free from alcohol, which sometimes 
is objectionable. — [Am. Journ. of Pharmacy. 

On Glycerin Ointment. By John H. Ecky, M.D., Philadelphia. 

Dear Sir — I send you a formula for an ointment which I 
have found very useful for chapped hands, lips, excoriations of 
the skin, &c, &c. I have called it Glycerin Ointment. 
^ Spermaceti, 5ss. 

White wax, 3j. 

Oil of almonds, I ij. (f.) 

Glycerin, 5j (f.) 

Melt the wax and spermaceti with the oil of almonds at a 
moderate heat ; put these into a wedgewood mortar, add the 
glycerin, and rub until well mixed and cold. I have used this 
ointment in my own family, and distributed much of it among 
my friends, and can testify to its value. 

I am not aware that an ointment of which glycerin forms a 
part has been proposed, and yet few physicians are ignorant 
of its property of protecting and soothing inflamed surfaces of 
the skin and mucous membrane. To such, however, as are 
unacquainted with its valuable properties, I would refer them 
to the article on glycerin, in the last edition of Wood & Bache's 
Dispensatory. — [Ibid. 

Solution of Gum Shellac in Alcohol. 

Since Professor Dugas's notice of gum shellac in alcoholic 

solution as a valuable external application to arthritic joints. I 

ested it to a patient who has long been a sufferer with 

chronic rheumatism, and learned that at least four years ago 

124 Sulphuric Acid in Diarrhoea. [February, 

he applied it on the recommendation of a physician, and with 
great relief for the moment. Finding it to fail after a while, 
he tried what he termed '* abetter coating" for the joints, which 
was a fresh egg beaten up with salt and spirits turpentine. 
This he found more impermeable than the former, but like it 
was temporary in the relief it afforded. — \_New Orleans Month- 
ly Medical Register. 

Sulphuric Acid in Diarrhoea. By John L. Vandervoort, M.D. 

Diarrhoea, as met with in young children, especially during 
the heat of summer, not unfrequently proves a troublesome 
and intractable disease, resisting the antacid and astringent 
treatment so commonly resorted to. During the past summer 
it was unusually prevalent throughout the city, the stools being 
frequent, and of a mucous or watery character, accompanied 
by little pain, except when the intestines were distended with 
flatus. Failing with the remedies usually employed, I resorted 
to the use of sulphuric acid, as suggested by several London 
and provincial physicians. It was first given in an obstinate 
case at Yorkville; the child was teething, and was naturally 
robust and healthy. For several weeks he had had more or 
less looseness of the bowels, with occasionally slight vomiting, 
and discharges of mucus, tinged with blood. Strict regimen 
and minute doses of blue mass and opium failing to exercise 
more than temporary effect upon the disease, and observing 
that his gums had become spongy and disposed to bleed upon 
the slightest touch, I changed his treatment, and gave him four 
drops of the acid in a wineglassfull of sweetened water several 
times a day. Seeing him again in a couple of days, I found 
him much improved ; his discharges were less frequent; there 
had been no more vomiting or bleeding from the gums. The 
same treatment was continued for a week, when the child's 
health was quite restored. In several other cases of similar 
character, the acid was given, and with like happy results ; and 
within a few days an infant, which had been troubled with ex- 
cessive looseness of the bowels for nearly a week, was cured by 
a few doses. 

One very great advantage which this remedy has over those 
in general use, is its agreeable taste, resembling in this respect 
lemonade ; hence it is well adapted to children whose aversion 
to medicine cannot readily be overcome. 

In a late number of the Provincial Medical and Surgical 
Journal, is a paper on this subject, by Mr. Sheppard, in which 
he alludes to upwards of fifty cases of diarrhoea, many of them 
very severe, in which he had used the sulphuric acid; in only 


1853.] Iodide of Arsenic in Psoriasis PaJmaris. 125 

one instance did it fail, and in that case the chalk arid astringent 
treatment was also unsuccessful. Mis experience led him to- 
the following conclusions: — 

1st. It is more efficacious than alkalies, opiates, and astrin- 
gents, in a proportion greatly exceeding' ten to one. 

2nd. It is more rapid in its action (especially in children,) 
in a proportion greatly exceeding twenty to one. 

3rd. It seems to act in a more rational and (if I may so ex- 
press myself) scientific manner, by increasing the tone of the 
mucous membrane of the alimentary canal, rather than by 
simply ast ringing its pores. 

4th. The worse the case, the more rapid and marvelous 
seems to be the cure ; a most striking feature, as compared with 
the treatment by chalk and opium. — [iV. Y. Medical Times. 

Psoriasis Palmaris cured by Iodide of Arsenic. By J. F. 
Saxford, M. D., Professor of Surgery in the Iowa State 

Mr. J. Reed, of this city, merchant, aged 38 years, of san- 
guine temperament and vigorous constitution, applied to me, 
some time during the past July, on account of a disagreeable 
and troublesome affection of the hands and feet, with which he 
had suffered for the previous five years. Upon examination we 
found the palmar surface of both hands, wrists, and the heels of 
both feet covered with thick dense epidermal scales, very dry 
and hard, with deep fissures or cracks extending in the direc- 
tion of the natural furrows of the palm and fingers. The hands 
and feet were extremely stiff and painful, and any attempt to 
use them suddenly, was attended with an increase of pain and 
bleeding from the cracked portion of the diseased surfaces. 
There was also a very troublesome pricking or tingiing sensa- 
tion in the parts and a burning or itching that much annoyed 
the patient. The eruption in question made its appearance by 
one or more inflamed and painful spots, of a dull red color, 
which extended in various directions, frequently coalescing. 
After a short time these patches became covered with scales, 
which increased in number and thickness until the epidermis 
seemed thick and hard as leather, and cracked as above men- 
tioned. Occasionally when these inflamed spots occurred in 
exposed situations, they would suppurate and thus augment the 
suffering and discomfort of the patient. The discharge tmm 
these little abscesses was thin and sanioos, and alter its escape 
the spots seemed disposed to heal without those further cha 
described as occurring when suppuration did not take place. 

Inquiries were made relative to the influence of season upon 

J 26 Iodide of Arsenic in Psoriasis Palmaris. [February, 

the development of the disease, but it did not appear that it 
underwent any great change at any particular time. The 
eruption had been constantly present, to some extent, for five 
years, and although partially disappearing occasionally, these 
periods of partial exemption had no connection, as far as the 
patient was aware, with the season or with his habits of life. 

He had applied to numerous physicians, from whom he had 
doubtless taken the usual remedies, and had also used various 
popular medicines, but without relief. 

The cause of the disease, in this case, was obscure. There 
was no constitutional indisposition, nor any thing in the patient's 
occupation or habits, that could act as a local irritant in its pro- 
duction. His general health was remarkably good ; he had not 
suffered a functional disturbance for months, and presented, 
when I saw him, otherwise than in the respect mentioned, a 
perfect physiological condition. 

I commenced the treatment by ordering him to drink freely 
of cream tartar, until the bowels were moved, and to apply at 
night a bread and milk poultice to the diseased parts. The 
poultices, which he had frequently applied, always relieved the 
heat and pricking of the parts, and softened the thickened epi- 
dermis, so that he could scrape away considerable portions after 
its removal. During the day he kept a cloth to the feet, wet in 
a strong solution of the Bicarb, of Soda, and frequently washed 
the hands in the same. 

I was led to the employment of Iodide of Arsenic, by acci- 
cent. I had intended, after a brief preparatory treatment, to 
place the patient on a more energetic course, and had thought 
of the Liquor Hydriodatis Arsenici et Hydrargyri, as the medi- 
cine to be used, as recommended by Dr. Graves, of Dublin. 
Finding myself unable to procure this at our drug stores, and 
having much confidence in the combination of Iodine and Ar- 
senic in the treatment of various cutaneous diseases, I resorted 
to the Iodide of Arsenic. 

Eight grains of this medicine were dissolved in four ounces 
of distilled water. Of this solution, twenty drops were given 
three times a day, in a few drams of sweetened water. At the 
same time, fifteen grains of the same medicine was thoroughly 
incorporated with one ounce of simple cerate, a small portion 
of which was well applied to the diseased surfaces every morn- 
ing after the removal of the poultice. The parts were thus in 
a soft state, admitting, without pain, the removal of the thicken- 
ed cuticle, after which they were in good condition to receive 
the ointment. 

This treatment was followed by the most decided and happy 
results. In two weeks the patient was very much improved, 

1853.] Treatment of Chilblains. 127 

and in six weeks from the time it was commenced, no vestige 
of the disease remained. Two months have elapsed since the 
cure appeared complete, and there is no return of the disease. 
This being the 6rst thorough disappearance of the eruption in, 
five years, together with its exemption from the modifying 
influences of the season encourage me lo believe that the cure 
is permanent. 

The prompt and decided effects of the Iodide of Arsenic in a 
case calculated to test its curative powers, justifies the infer- 
ence that it is a remedy of peculiar efficacy in the treatment of 
the various forms of Psoriasis. No disagreeable local or con- 
stitutional effects followed its use. 

I am at this time employing the same remedy in a protract- 
ed case of Pityriasis, with the prospect of a similar happy result. 
[ Western Medico-Chirurg. Journal. 

On the Treatment of Chilblains. By M. Trousseau. 

M. Trousseau washes all parts affected with chilblains, three 
times a-day. with the following lotion : — Borax, 50 parts; wa- 
ter, 500. Four table-spoonfuls are added to a quart of water. 
He also prescribes, both for the prevention and removal of 
chilblains, the following lotion, to be used night and morn- 
ins::— Sal ammoniac, 20 parts; water, 40; proof spirit, 10. 
When ulceration has occurred, he prescribes one of the follow- 
ing formulae : — Tannin, 10 parts ; water, 500. Or, ext. rhatany, 
10 parts; quince mucilage, q. s. This is mixed up as a soft 
electuary, with which the parts are smeared; and the applica- 
tion is also an excellent one for the cracked lips which occur in 
the winter. — [Z/ Union Med. Med. Chir. Rev. 

ill i s c c 1 1 a n ti . 

Aromatic Schiedcun Schnapps. — The sale of Holland gin, neatly 
put up in medicinal bottles and labelled as above, accompanied with 
the highest encomiums of its wonderful efficacv in innumerable dis- 
is one of the most cunning and nefarious devices we know of 
for leading the unwary into the vice of intemperance. We have 
lately noticed it repeatedly upon mantel pieces, alon^ with " other vials 
of physio," and apprehend that it will become one of the most popular 
nostrum* of the day. It is said that one of its greatest recommenda- 
tions is that "it is not bad to take." 

128 Miscellany. [February, 

Dr. Drake's work on the Diseases of the Interior Valley of North 
America. — We are happy to learn that Dr. Drake had prepared a 
considerable portion of the second volume of this great work, and 
that it is the desire and intention of his children that the portion so 
prepared should not be lost to the Profession. It is to be revised by 
a competent person and printed as soon as possible. 

Ligatures of large Arteries, by Prof. Roux. — M. Roux, the Nestor 
of French Surgery, occasionally furnishes the statistics of his exten- 
sive experience. In a paper communicated to the Chirurgical Society 
we find that he has ligated the popliteal artery once, the femoral 46 
times, the brachial 20 times, the carotid 6 times, the axilary 4 
times, the sub-clavian 3 times, and the external iliac twice — making 
82 operations. 

Ink for the Million. — To the Editor of the American Journal of 
Pharmacy : The following formula for making a very superior ink is 
not generally known. The facility of its preparation, and its almost 
incredible cheapness, (about two cents a gallon,) render it worthy a 
place in your Journal. 

ft. 12 oz. avoird. Ext. Logwood, 
^ oz. " Bichromate Potash. 
5 gallons water; 
Dissolve the ingredients separately in water and mix them together, 
and in a short time the ink will be fit for use. 

An analysis of the above would be very desirable. 

As an instance of the very great coloring property of hsematoxylon, 
I have found that l-100th of a grain dissolved in 4,000,000 times that 
quantity of water, will be tinged a fine pink color by the addition of a 
little aqua ammonia. Yours truly, 

Philadelphia, Sept. 13, 1852. W. H. Pile. 

Electricity. — Professor Faraday has instituted a series of experi- 
ments, with a view to determine the quantity of electricity connected 
with the atoms or particles of matter. He says, it is wonderful to 
observe how small a quantity of a compound body is capable of be- 
ing decomposed by a certain quantity of electricity. " One grain of 
water will require for decomposition, an electric current equal to a 
very powerful flash of lightning." The chemical action of a grain 
of water upon four grains of zinc, can evolve electricity equal in 
quantity to that of a powerful thunderstorm ; and he states, that from 
his experiments it would appear, that 800,000 such charges of the 
Leyden battery would be necessary to supply electricity sufficient to 
decompose a single grain of water. The Leyden battery of which 
he speaks consists of fifteen jars, containing 3510 square inches, or 

1853.] Miscellany. 129 

about twenty-four and a half square feet of coated glass, charged by 
thirty turns of a plate electrical machine, the plate being fifty inches 
in diameter, and of immense power, giving ten or twelve sparks an 
inch long for each revolution. The author of a paper on this subject 
in the Philosophical Magazine, remarks, that "the estimate that 
800,000 discharges of the battery of fifteen jars, equal to a powerful 
flash of lightning, would be necessary to resolve a single grain of 
water into its elements, is certainly astounding, when it is recollected 
that, according to Professor Faraday, the quantity of electricity that 
decomposes a body, is the equivalent quantity of electricity that had 
previously held the elements of that body in combination ; for he, 
with Davy and others, conceives that electricity and chemical affinity 
are identical powers. Hence in one grain, that is, one drop of water, 
there must be naturally existing, and constituting the affinity between 
its oxygen and hydrogen, no less a quantity of electricity, than 
800,000 charges of a battery containing :3.*)10 square inches of coated 
glass, or the equivalent of a very powerful flash of lightning. If 
this quantity of electricity were converted into one spark, it would 
be 4166 miles in length, taking Professor Faraday's mean estimate of 
one charge of his battery as the basis of calculation. — [Annals of 
American Pharmacy. 

Muscular jiower of the Insane, by M. Morel. — A general popular 
error prevails, that the insane are endowed with inordinate muscular 
p >wer, and this explains, why so many persons are brought to the 
Mareville Asylum tied and corded. When M. Morel was first ap- 
pointed to this, he found numerous patients bound up, reputed dan- 
gerous, and especially so, because of their vociferations. He set 
them at liberty without any ill effect, and attributes much of the vio- 
lence that had previously occurred to the ill conduct of the attendants. 
He agrees with Jacobi, that as a general rule, the insane exhibit no 
inordinate muscular power, and some of the patients of almost 
collossal stature are easily managed by one person. Indeed, the 
insane when engaged in manual labor, soon tire and require frequent 
repose. If some of them by exception, work with a feverish activity, 
and display great strength, the majority are dejected and languid. 
The persons in whom he has met with the greatest developement of 
muscular power, belong to the following categories. 1. Persons of 
small stature, delicate complexions, and nervous temperament, and 
especially females who appear exhausted by their cries and agitations. 
Among snch miserable looking beings, a power of resistance is de- 
veloped under certain circumstances, which defies the united ener- 
gies of several attendants. 2. Insane epileptics. 3. Monomaniacs 
who are not yet exhausted by the disease, or irrational treatment. 
"W ben their passion is opposed, these persons sometimes manifest a 
resistance only to be overcome by several attendants. — [British and 
Foreign Mcdico-Chirurgical Review, from Annates Medico-Psycholo- 

130 Miscellany. [February, 


Principles of Human Physiology, with their chief applications to 
Psychology, Pathology, Therapeutics, Hygiene and Forensic Medi- 
cines. By William B. Carpenter, M. D., F. R. S., F. G. S., &c. 
Fifth American, from the fourth London edition. Philadelphia : 
Blanchard & Lea. 1853. 

The previous editions of this work have exhibited progressive 
improvement. Each has been better than its predecessor, more ac- 
curate and more elaborate. The rapid sale of it is but one of the 
evidences of the high estimate placed upon it by the profession. 

In order to justify this-' favorable opinion, to keep pace with the 
advance of the science and fully to present his more matured views 
of it, the author has remodelled his former work, entirely re-writing 
many of the most important chapters and adding several others upon 
topics not embraced, or imperfectly discussed in former editions. 

The changes are too numerous to admit of an extended notice in 
this place. At every point where the recent diligent labors of or- 
ganic chemists and micrographers have furnished interesting and 
valuable facts, they have been appropriated, and no pains have been 
spared in so incorporating and arranging them, that the work may 
constitute one harmonious system. These alterations, although they 
have greatly enhanced the value of the book, have unavoidably added 
to its bulk, until it is no longer well suited to the purposes of the student. 
Its appropriate place is the library of the physician. The present 
work, and the " Principles of General and Comparative Physiology," 
by the same author, form incomparably, the best treatise on Physiolo- 
gical Science in the English language. M....r. 

The Druggists General Receipt Book ; comprising a copious Vet- 
erinary Formulary and table of Veterinary Materia Medica ; 
numerous Recipes in Patent and Proprietary Medicines, Druggist's 
Nostrums, etc.; Perfumery and Cosmetics; trade, chemicals, &c, 
with an appendix of useful tables. By Henry Beasley. Second 
American, from the last London edition, corrected and enlarged. 
Philadelphia : Lindsay & Blakiston, 1853, 12 mo., pp. 472. 

This work is not intended for the Physician, and how far it will 
meet the wants of veterinarians and druggists, we are unable to say. 
It contains a vast number of receipts, which may be found useful on 
some occasions. The pages devoted to patent and proprietary medi- 
cines is of some interest to the physician, as it affords him a know- 
ledge of the composition of many of the nostrums which are in fre- 
quent use in domestic practice. G. 

1853.] Miscellany. 131 

Materia Medica or Pharmacology and Therapeutics. By William 
Tillv, M. I). Vol. 1, No. 1., November, 18.52. Springfield: 
George VV. Wilson's Power Press. 1852. 8vo. pp. (i 1. 

This work is to be published in monthly numbers, until it is corn- 
pleted. Us author bafl been long known to tbe profession, as a gen- 
tleman of considerable ability who has devoted much ;itt« ntlOfl to the 
subject of which he treats. The work is to be "original, having 
none of the characteristics of a compilation." A proper estimate 
of the work cannot be formed from an examination of a single num- 
ber ; but if Dr. Tully's opinions upon other questions are as erroneous 
as those he advances on the subject of tbe absorption of medicinal 
substances, it is not probable that the profession generally will concur 
with a friend of Dr. Tully, who predicts that this work "will be the 
most original philosophical and practically useful book for the physi- 
cian which has appeared since the writings of Sydenham." 

It is supposed that about twenty numbers will complete the work. 
The price is twenty-five cents for each number. G. 

The Physicians Pocket Dose and Symptom Book ; containing the 
doses anl uses of all the principal articles of the Materia Medica, 
and chief officinal preparations, etc., etc. By Joseph H. Wythes, 
M L)., author of the " Microscopist," etc. Philadelphia: Lindsay 
& Blakiston. 1853. 1 vol. 12 mo., pp. 246. 

The title of this little work very clearly indicates its character. 
The author supposes that " it might prove of service in the treat- 
ment of disease," and that it will prove acceptable to the "country 
practitioner." We are sick of the frequent disparaging references 
to country practitioners. Surely as high a degree of intellect and 
professional knowledge is required for country as for any other prac- 
tice ; and we are fully persuaded that .our country practitioners gen- 
erally, have as little use for " vade mecums" and "pocket remem- 
brancers," as any other class of practitioners. If such a work as 
this is at all useful, it will be to those students of medicine who are 
"cramming" for an examination for which they do not feel exactly 
prepared. G. 

Hand-Books of Natural Philosophy and Astronomy. By Dvomsius 
Lardner, D. C. L., &c. &c S cond course. Heat — Magnetism — 
Common Electricity — Voltaic Electricity. Illustrated by upwards 
of 200 engravings on wood. Philad. : Blanchard vSc Lea. 1853. 

This is one of those admirable works, for the construction of which 
Dr. Lardner has such peculiar talent. It presents a condensed, yet 
lucid embodiment, of the present advanced state of knowledge, upon 

132 Miscellany. 

subjects that must ever be interesting to the admirer of nature's won- 
derful manifestations of the greatness and wisdom of the Creator. 

Braithwaite's Retrospect of Practical Medicine and, Surgery. Part 
26.— 1853. 

This number sustains the well-established reputation of the work ; 
but, like its predecessors and its rival, Ranking's Abstract, it is almost 
bare of American intelligence. 

New Medical Journals. — We have received the first issue of "The 
Southern Journal of the Medical and Physical Sciences," edited by 
Drs. Jno. W. King, Wm. P. Jones, R. O. Curry and B. Wood, and 
published bi-monthly at Nashville, Tennessee. It is full of interest- 
ing matter and handsomely printed. 

We have also received the Medical Recorder, published bi-monthly 
by the Memphis Medical College, edited by Professors Merrill and 
Quintard. It contains only 16 pages, but verifies the axiom, that 
"good things are put up in small packages. 

We wish our confreres a full tide of success — and have added 
them to our list of exchanges. 


In addition to the above works, we are indebted to the authors and 
publishers for the following pamphlets : — Professional Reminiscences 
of Foreign Travel, by W. Channing,M. D., of Boston. The Inaug- 
ural Address of Worthington Hooker, M. D., &c, &c, upon "the 
present mental attitude and tendencies of the Medical profession." 
History of the Medical Department of the University of Louisville : 
an introductory Lecture, delivered by Prof. L. P. Yandell. A popu- 
lar Address, by Dr. W. F. Barr, before the Medical Society of East 
Tennessee. Proceedings of the National Pharmaceutical Conven- 
tion, held at Philadelphia, in Oct., 1852. Congressional Report of 
Hon. E. Stanley, of North Carolina, and Hon. Alex. Evans, of Ma- 
ryland, on the Ether discovery. Congressional Report of Hon. W. 
H. Bissell, of Illinois, Chairman, upon the Memorial of Dr. W. T. 
G. Morton asking remuneration for the discovery of the anaesthetic 
properties of Sulphuric Ether. Discovery of the late Dr. H. Wells, 
of the applicability of the Nitrous Oxyd Gas, Sulphuric Ether and 
other vapours, in surgical operations, &c. And a number of useful 
catalogues from the large publishers of medical and scientific works. 

Erratum. — On p. 17 of last No., line 18 from top, read ter-cliloride, 
instead of " too, chloride". 



Vol. 9.] NEW SERIES. — 31ARC1I, hi!. [No. 3. 


Original (I o m m it n i c a 1 1 o n s . 


Remarks mi an Operation for the Radical Cure of Hernia. 
By W. II. Robert, M. D., of Orion, Pike Co., Alabama. 

A.I the subject of Hernia is at present attracting a great deal 
of attention from the learned and skilful of the day, perhaps a 
relation of my experience in the treatment of this disease may 
not be amiss. 

In J 846, a Dr. Woozencraft (probably the same now in Cali- 
fornia as Indian agent) passed through Georgia, offering to sell 
an Instrument, and the right to operate with it, for the cure of 
Scrotal Hernia. The instrument was a very small silver syr- 
w hose canula was about an inch long, and terminated in 
a trocar-shaped steel point. Two small orifices existed in the 
side of the canula near the steel point, from which the fluid 
contained in the syringe made its exit. This instrument would 
probably have held from 30 to 50 drops of fluid. Dr. Woozen- 
craft's manner of operating, was — to purge the patient freely 
a day previous, and give* a large anodyne in the morning to 
quiet the bowels; a good truss was then put around the body 
to be ready for application ; the intestines were returned by 
and the instrument (previously filled with the oil of 
cl«»ves, or tinet. cantharides) was passed in the canal just at its 
junction with the scrotum. To ascertain if any tissue was 

n. s. — VOL. IX. no. in. 9 

134 Robert, on Hernia. [March, 

intervening, and to be sure that the instrument was at least at 
or near the canal, the point was made to move about in various 
directions ; one finger of the unoccupied hand was pressed 
upon the point of the instrument to ascertain if all was right ; 
the fluid was then forced up to the canal, and the instrument 
withdrawn. The truss was immediately applied to prevent, 
by its pressure, the descent of the intestines. In about twenty- 
four hours there would commence a deposition of plastic lymph, 
which, Dr. Woozencraft argued, would cause an agglutination 
of the parietes, or an impaction of the inguinal canal. 

As the price demanded by Dr. Woozencraft, for an instru- 
ment and the right of a county, was so exorbitant, I did not 
bite at that time, but waited a better opportunity. A few 
months after, I purchased an instrument from a man who had 
them for sale, probably as agent. My instrument differs some 
little from the one used by Dr. Woozencraft in having a lancet 

Having taken notes at the bed-side of the first patient upon 
whom I operated, it is the only one I shall give in detail. 

Case 1. Burrell, a negro man, aged about 74 years, in fine 
health ; he has been ruptured twelve or fifteen years. April 15, 
1840, I operated on him by injecting at the external ring about 
20 drops of the oil of cloves, in the presence of Drs. Ogilby, 
Jones, Wingfield, Howard, and Anderson, and Messrs. Wright 
and Man, students of medicine. He complained very little of 
the operation; after which, I applied one of Chase's trusses, to 
prevent the descent of the intestines. 

16th, 10 o'clock, A. M. Patient had vomited some, which 
caused the descent of the intestines. I returned them very easi- 
ly. Until now, he had not complained in the least of pain. 12 
o'clock, M. — Complains very much of pain in the parts, which 
are swelled, tense and very painful to the touch. So far, the 
swelling is in the bottom of the scrotum. 7 o'clock, P. M. — In- 
flammation gradually progressing towards the external ring; 
he has not vomited since morning. I have allowed him small 
quantities of whiskey to-day, as he has been accustomed to the 
daily use of it. Pulse natural. 

17th, 8 o'clock, A. M. Patient complains very much of the 
inflamed parts — they appear to be assuming the condition I 

1853.] Robert, on Hernia. 185 

should think necessary to the radical cure of hernia, that is, 
the deposition of a large quantity of plastic lymph ; he lias not 
vomited since yesterday, and then only once ; appetite good, 
and pulse natural. 6 o'clock, P. M. — Scrotum has been very 
much distended to-day, but is more flaccid at this hour, still 
very tender to the touch, especially about the ramus of ihe 
pubis, lie has had an operation from his bowels. His pulse 
has been a little excited to-day, but very little. 

18th, 8 o'clock, A. M. Burrell passed a good nighl : tumor 
not so painful as yesterday — not so large ; thai pari of it which 
is near the external ring has a very firm feel. He had an evacu- 
ation from the bowels of firm consistance, and very painful. 
Pulse natural, and spirits good. Ordered, a dose of casioroil. 

19th, A.M. Tumefaction about the same as at last report, 
deposite so great as to occupy the whole of that side of the 
scrotum; says he has very little pain. The; I i he a 

perfect filling up of all, from the external ring to the bottom of 
the scrotum of the same side. 

20th. Report differs in no way from yesterday. From this 
date the effusion Was gradually absorbed, and al the end of a 
month, notwithstanding the use of a good truss, his hernia was 
as bad as ever. 

Case -J. In Glennville, Ala., July 24th, 1847, I operated on 
a middle-aged negro, ruptured on the right side. lie was tem- 
porarily relieved, but the hernia returned in about a month. It 
is pro: .\ ever, that he was put to hard work (cutting 

saw-logs) as soon as he was relieved from the immediate effects 
of the operation. 

Case 3. In September following, I operated on a negro 
man, s. This negro was ruptured on the right 

side, and was also laboring un ler ascites, with a fluid distention 
of the scrotum. When last heard from lie remained well of 
the hernia. 

C kSE I. At the same time as the above, I operated on Mr. 
C. J., a young gentleman aged 21 years, ruptured on the right 
side. lion produced no effect whatever. In two 

rain, without even temporary bei 
5 and 6. In October following, I operated un two 
blacks, without any permanent effect. 

136 Robert, on Hernia. [March, 

All the negroes operated on were put to hard work as soon 
as they were seni home, so that, even if the operation promised 
anything, the chances of success were thus very much dimin- 
ished, if not entirely destroyed. 

So far as the danger of the operation is concerned, I have 
yet to learn that any existed. / have even seen the intestines 
come down the day after the operation, and returned without 
any bad consequences. I have seen the oil of cloves thrown 
into the canal, when a portion of the omentum was yet unre- 
turned. This being returned, no more was thought of it. 

Since the latter part of 1847, I have not operated at all ; and 
if I were called upon again to make an attempt to relieve a case 
of hernia, I would rather trust to the application of a small 
seton at the external ring than to an operation of this kind. It 
is a well established fact, that when irritating injections fail to 
relieve hydrocele, a small seton through the sack is almost sure 
to cure it, by the deposition of a large quantity of coagulable 
lymph. The seton is much more likely to produce constitu- 
tional disturbances, and is consequently rather more dangerous ; 
but I feel certain that it is much more likely to block up the 
external ring than any injection. 

Case 7. In May last, I operated on Mr. C. for strangulated 
hernia. A fold of the intestine, about six inches long, and a 
portion of the omentum had descenced, and at the time of 
operating they were very badly strangulated. I returned the 
intestine, but being fearful that the omentum was too far gone, 
I determined to let it remain where it was — to relieve itself of 
suppuration ; and, moreover, to see what effect a long-continu- 
ed suppuration would have in curing the hernia permanently. 
Suppuration continued about a month — all the strangulated 
omentum sloughed away, and the external ring appeared to be 
blocked up. 

I saw Mr. C. again in December last. There never had 
been any descent of any of the viscera since the operation. 
The intestines would pass down the canal to the external ring, 
and there seem to be arrested by its occlusion. He had never 
worn a truss. Further time is necessary to determine as to 
the permanency of the cure. 

Case 8. On the 21st of November last, I operated on a gen- 

1853.] Robert, on Hernia. 137 

tleman fifty years of age, fur the relief of strangulated hernia. 
He had heen ruptured for twelve or fifteen years, and lately 
had been very much troubled with a descent of another portion 
of the viscera, lie bad generally been relieved by purgation, 
This course, however, had failed to relieve him of his present 
attack. I should think that from the moment of the descent 
the strangulation became perfect ; for in less than an hour after, 
he had vomiting and hiccough, which continued, with very lit- 
tle intermission, until the completion of the operation. 

I operated twenty-four hours after the accident. There 
was a very great depression of the vital energies. His skin 
was very cool, extremities so cold as to require artificial heat 
to them, constant shivering, pulse 130 to the minute and very 
weak. On cutting down, 1 found the old hernia to consist of a 
portion of the omentum, which had become so closely adherent 
to the scrotum as almost to constitute a portion of it. The 
recent hernia consisted of a fold of the small intestines about 
four inches long, and so tightly constricted as to make it very 
difficult and dangerous to pass up the probe pointed bistoury 
to divide it. As careful as I had to be, I cut my tinker in pro- 
tecting the intestines. After so long a time, I succeeded in 
passing the knife and removing the difficulty. Three hours 
after the operation, when reaction had become fully establish- 
ed, I found that a small artery, which had been divided in the 
first cut through the skin, was now bleeding freely. The whole 
scrotum was filled up to the external ring with coagula. I se- 
cured the ends of the artery with ligatures, and removed as 
much of the coagulum as possible; yet a great deal remained. 
I anain united the edges with sutures and adhesive strips. Very 
little suppuration afterwards took place; the remaining coagu- 
la were probably absorbed. He recovered rapidly, and was 
uj> in ten days. Up to this day he has had no return of the 

So far, Mr. Editor, as my experience will warrant the opin- 
ion, I think that many cases of strangulated hernia are ren- 
dered fatal by the severe and long-continued taxis which is 
frequently i to. Let u 

case of strangulated hernia. The patient has been ruptured 
for a long series of years ; this portion of the viscera (be it 

138 Hamilton's Case of Mortification. [March, 

omentum or intestine) has never been returned, we must rea- 
sonably presume adhesion to have taken place : another portion 
of the viscera comes down and becomes strangulated — can 
any one for a moment suppose that taxis will relieve such a 
case? An how can any one discriminate these portions — the 
one strangulated and the other not — without cutting down to 
them ? 

Again, I have seen cases rendered fatal by delay, from a 
false opinion entertained by some surgeons of the great danger 
attending these operations. I am satisfied that the patient suf- 
fers as much pain before as during an operation to relieve the 
strangulation. The operation of itself does not seem to me to 
be necessarily hazardous. The large proportion of successful 
cases are those who received early the benefits of an operation. 

I have been insensibly drawn from common reducible hernia, 
to cases of strangulated hernia. In the illustration of my 
views, my cases of strangulated hernia presented points which 
I was desirous of bringing forward, and hence the blending of 
one kind with the other. The above article contains my own 
views upon this all-important disease. However much they 
may differ from those of others, I honestly entertain them, and 
therefore do not hesitate to submit them to the profession. 


Extraordinary Case of Mortification, occasioned by Pregnan- 
cy. By Samuel L. Hamilton, M. D., of Chattooga county, 

Mrs. S., aged twenty years, duiing the sixth month of her 
second pregnancy, was attacked June 5th, 1848, with remittent 
fever, which readily yielded to ordinary treatment. After this 
she did well for twelve or fifteen days, during which time 
nothing of importance occurred, but she was perhaps unusual- 
ly hearty, which I attributed to her condition. 

On the morning of the 20th of June I was again called to see 
her, and found her with extreme pain in the toes of her right 
limb, which was so cold half way to the knee as to yield to the 

1853.] Hamilton's Case of Mortification. 139 

hand when applied the same sensation as that of a dead hod}'. 
There was little or no excitement of the pulse; nor was there 
any evidence of disease in the general system. The pain in 
the foot increased from day to day, until the cries and shrieks 
of the unfortunate sufferer were almost too intolerable to be 
borne by her surrounding friends. It cannot be said that she 
was entirely easy until her delivery, except while under the 
influence of large doses of morphine, from the effects of which 
she would frequently awake in violent pain. Her sleep was 
evidently not profound, under as large doses of the above medi- 
cine as it is thought prudent to administer under any circum- 
stances. It was attempted, but in vain, to restore the lost 
temperature of the extremity — every thing was used that would 
promise this result, without vesicating the skin, which was 
avoided, notwithstanding the repeated solicitation of friends for 
the application of a fly-blister. There finally appeared large 
yellow blisters upon the diseased surface, which, on being rup- 
tured, discharged a serous fluid. It was evident, after this, that 
there was not sufficient vitality in the skin to warrant recove- 
ry. The skin and all the soft tissues now began to slough, 
until the ligaments of the metatarsal articulations were destroy- 
ed — at this point they were separated, which gave the patient 
some slight relief. The temperature of the limb was partially 
restored from above, down to within a short distance of the 
ankle-joint; the pain, however, continued unabated 'till labor 
came on, when it then entirely ceased. The lady was then 
delivered of a large child, after which there was not the slight- 
est return of pain. The labor was in all respects natural — the 
stump of the extremity, which had been suppurating, now readi- 
ly healed — the woman recovered, and has since given birth to 
two children, without the slightest return of the affection. 

I was constrained to the opinion that this extraordinary case 
wa^ the result of p.essure of the gravid uterus upon the 
arteries and nerves passing through the pelvis — viz., the ext. 
iliac artery and the great sciatic nerve, whose extremities sup- 
ply nutrition and innervation to the disorganized part. From 
the history of her previous pregnancy, it appeared thai there 
had been running ulcers from about the sixth month until de- 
livery; the cicatrices were still perceptible, and occupied the 

140 Harper's Case of Retained Placenta. [March, 

regions covering the posterior and anterior tibial arteries. I 
think it a reasonable inference, that the pressure was exerted 
upon the nerves, as well as the arteries, from the intense and 
continuous pain which nothing could relieve until the removal 
of the cause, when the suffering simultaneously disappeared. 

As to the treatment of the case, opium may have given some 
temporary relief. Position was tried without the least success. 
Supporters were also tried with the same result. We would 
feel inclined, however, were we called to treat another case, 
to try more thoroughly, both supporters and position. We 
might particularize as to local applications, &c, but they were 
such as common sense would dictate, and failed to afford any 
relief — we therefore omit their tedious detail. 

article x. 

A Case of Retained Placenta. By P. W. Harper, M. D., of 
of Laneville, Hancock Co., Georgia. 

On the 12th of last October, I was requested by my young 
friend, Dr. George W. Darden, of the Shoals of Ogeechee, to 
visit Miss C, of Warren county, thirty-one years of age. Be- 
fore proceeding in detail with her case, it may not be amiss to 
say, that her feet are very much affected with the deformity 
familiarly called club-foot. She measures, from the sole of her 
foot to the knee-joint, 13^ inches; from her knee-joint to her 
hip-bone ; 11 inches; from her hip-joint to the crown of her 
head, 23| inches — making her exactly four feet high, of strong 
and healthy constitution, with no deformity about the pelvis 
that we could discover. 

On my arrival, I ascertained she had been in labor about 
thirty hours. The membranes had been ruptured several hours 
before I saw her. On examination, I found the case natural, 
and of the fourth presentation. There was considerable rigid- 
ity of the parts, particularly the os uteri, which impeded the 
further descent of the occiput from the left acelnhulum. We 
took sixteen ounces of blood from the arm, and then made 
another examination, and found the same contraction as before, 
without any progress of the child's head. The bowels having 

1853.] Harper's Case of Retained Placenta. 141 

been freely opened by a purgative, we gave her a dose of mor- 
phine, and left her to rest during the night. On examination 
the next morning, the parts were relaxed, and the OS uteri so 
dilated as to admit the whole of the occiput into the left aceta- 
bulum with the anterior fontanel resting a little above the left 
symphysis pubis. The pains became very regular, and as we 
supposed would now expell the child ; but in this we were dis- 
appointed. The head became so impacted in the pelvis, from 
its large size, that no efforts we could prudently use changed 
the relative position of the head : we could neither make it ad- 
vance nor recede. In this situation she remained until the next 
day (14th), when, as the last resort, we had to lessen the size 
of the head, by perforating it at the posterior fontanel, and 
emptying it of its contents. Several hours yet elapsed before 
we could effect the delivery of the head, around the neck of 
which the funis was wrapped ; this, placed immediately under 
the symphysis pubis, with the size of the child, weighing ten 
pounds, added greatly to the delay of the expulsion of the 
shoulders. After the delivery of the shoulders, she seemed 
much prostrated, and all pain ceased. For two or three hours, 
we gave the wine of ergot, in table-spoonful doses, every twen- 
ty minutes, without any effect whatever. We then had to use 
force by extension and counter-extension, which soon effected 
the delivery, at 12 o'clock, P. M., on the 14th, after having been 
in labour from the 11th, say four days. We then proceeded 
to extract the placenta, but here we met with insuperable dif- 
ficulties by the contraction of the uterus, though not the hour- 
glass contraction. All efforts having failed, we had to desist. 
We gave her a dose of castor oil, and left her, with directions 
to take morphine after the bowels were opened, to be seen the 
next morning. 

15th. On our visit, we found the uterus relaxed ; but, on ac* 
count of the parts becoming so very sore and sensitive, we 
could not extract the placenta, which was attached at or near 
the fundus Kim. The only alternative which seemed to be left 
us now was to use emolient and soothing injections up the 
vagina and into the uterus, and to meet whatever contingencies 
might happen, and to trust the case to the efforts of nature 
until the next day. 

142 Dugas's Case of Club-foot. [March, 

16th. Rested pretty well during the night ; with some fever, 
though the pulse soft and compressible; seems revived; com- 
plains of great soreness to the touch, and the parts much swol- 
len. No portion of the placenta could we extract. Directed 
equal parts of milk and warm water injected three times a-day ; 
dose of castor oil and morphine at night. 

17th. The bowels were moved, and she rested tolerably well 
during the night ; pulse 130, weak, and much fetor in the room. 
Efforts made to extract the placenta, but failed. Same injec- 
tion continued, and morphine to be given at such intervals as 
to compose. 

18th. Did not rest well the preceding night ; pulse about the 
same as the day before; great thirst, and some portions of the 
placenta have come away, putrid and very offensive. Emoli- 
ent injections with weak soap-suds and morphine directed. 

19th. Much worse, with an enlargement of the abdomen and 
great soreness about the uterus, as well as the other soft parts ; 
pulse 120, and weak; small portions of the placenta continue 
to be discharged. Directed the bowels to be moved with cas- 
tor oil, and the same injections and morphine. 

20th. Considerable distension of the whole abdominal region ; 
pulse quick and weak ; about two table-spoonfuls of the placen- 
ta have been discharged of the color and consistence of mo- 
lasses, and so very offensive as scarcely to suffer any one to 
remain in the room. Being insensible to all passing events, we 
left her, with the expectation of her dying during the day or 
night. She died about 4 o'clock, P. M. 


IS on-congenital Talipes Equinus. By L. A. Dugas, M.D., &c. 

Cases of accidental or non-congenital Club-foot, are so rare 
that no apology is necessary for reporting the following. It is 
the second only that the writer remembers to have seen. 

The subject of this case was James H., of this city, about 
nine years of age. When three years old, his limbs being 
perfect, he took scarlet fever and was very ill with it. After 
the eruptive period, he suffered a great deal with the pains 

1853.] Dugas's Case of Club-foot 143 

which sometimes attend this disease; and during the three 
suceeedin<_: years there seemed to be occasionally an impedi- 
ment in his walking, which was attributed to weakness or to 

something of a rheumatic nature. When six years of age, 
however, there was still no deformity whatever about the foot 
nor leg. Indeed, at that time, none but his parents could per- 
ceive any thing peculiar in his Lrait. But his lameness became 
gradually more and more evident, although he suffered no pain; 
his left heel was perceived to be a little elevated in walking, so 
as to throw the weight of the body upon the anterior part of 
the foot ; and this peculiarity went on increasing for a couple 
of years, until he walked upon the extremity alone of the met- 
atarsal bones, being utterly unable to reach the floor with the 
heel or to Ilex the loot in the least. 

I saw him for the first time on the 6th of April, 1852, and 
was then furnished with the above history. I found his left 
foot presenting all the features of talipes equinus in the extreme; 
the muscles of the left leg were very much atrophied, and, 
although there was no ankylosis, the tension of the tendo 
achillis was such as to prevent any motion of flexion ; the ex- 
tension of the foot seemed to be carried to the utmost possible 
degree, the instep being drawn back beyond the axis of the 
tibia, and the toes turned up towards the instep. On carefully 
measuring the two limbs, the left ankle was found to be about 
one inch above that of the right limb. In other words, the 
left limb was an inch shorter than the right one. 

It is probable that in this case, the immediate cause of the 
talipes is to be found in the gradually increasing disproportion 
in the length of the limbs, the child instinctively elevating the 
heel to compensate for the difference. Why the left limb did 
not grow as fast as the right is another question, which need 
not occupy us at present. 

A sub-cutaneous section of the tendo achillis was made, and 
four days afterwards an apparatus applied for the purpose of 
rectifying the deviation of the foot. This consisted of the 
sheet-iron splint and curved bar proposed some years ago by 
Dr. Chase. It ansv. i ed admirably in this case, as it has re- 
peatedly done in the several varieties of talipes in which I 
have used it. After wearing this about three weeks, my little 

144 McKinnon's Case of Monstrosity. [March, 

patient left it off, was able to walk, and his heel gradually came 
down to the ground — so that he was well in two months, and 
has remained so to this time. 
Augusta, Feb., 1853. 


Monstrosity. — [We are indebted to Dr. D. McKinnon, of 
Pike Co., Alabama, for a letter, from which we make the fol- 
lowing extract :] 

"Mrs. M., on the 3rd of November, 1852, after a tedi- 
ous labour, was delivered of a male child, weighing about seven 
pounds, and presenting the following appearances: — The head 
and limbs well developed, the stomach, duodenum, jejunum, 
ilium, coecum, colon, rectum, liver and spleen, were all on the 
outside of the abdomen, without any covering. The viscera 
protruded from an opening extending from the pubis to the 
umbilicus; the cardiac extremity of the stomach and the rec- 
tum were closely attached to the abdominal walls at said 
opening, the scrotum forming a part of the attachment of the 
rectum. There was no penis nor anus. The infant lived four 

(EcUctu Depart ment. 

Letters upon Syphilis. Addressed to the Editor of L'Union 
Medicale, by P. Ricord. Translated from the French, by 
D. D. Slade, M. D. 

[Continued from Page 112.] 
sixth letter. 

My dear Friend, — Let us continue this review of facts and 
arguments which have been opposed to my doctrines. 

There is an observer upon whose works my antagonists 
place great value, and they are in fact worthy of much esteem. 
I have cited them honorably in my preceding letter, and you 
see me disposed to accord to them the value which they merit. 
This observer, whose results have been opposed to me without 
cessation, is M. C. Martins. Well, what do the results of M. 
Martins prove in the elucidation of the great question of the 

1853.] Ricord's Letters on Syphilis, 1 16 

consequences of blennorrhagia as cause of syphilis ? Remark 
that it is i ely on accounl fthe accuracy of the observa- 
tion, of the scientific method employed by this observer, and 
in fine of his statistics, that they have made so much noise 

about his figures and his conclusions. What. then. do his figures 
say ' I find them very favorable to my doctrines. Js it by- 
complaisance 1 Judge of it ? 

M. Martins gives a statement of 60 observations of syphilitic 
eruptions. Now how many times has the chancre been noted 
as antecedent? 46 times, my dear friend. In 14 cases only, 
M. Martins assures us that he has found no other antecedent 
than simple blennorrhagia, two of which were accompanied 
with bubo, and two with orchitis. But M. Martins adds that 
he had not the opportunity to make the diagnosis of these cases 
of blennorrhagia. and that he trusted to the testimony of the 
patients. You know what I think upon this point. There are 
some testimonies, without doubt, that we ought to believe; but 
I shall always maintain that when there is a question of diag- 
nosis as difficult as that of chancre in the urethra, the testimony 
of people entirely strangers to the profession, often ignorant 
and narrow-minded, and who understand neither the sense nor 
the bearing of the question, is of very little value. Without 
doubt we accept testimony in some questions much more grave, 
in those of life and death ; but it does not follow that the testi- 
monies are always true, and the judgments always equitable. 

Permit me to offer you a general remark, which finds its 
place here. In many of the observations of M. Martins, as in 
several of those of M. Cazenave, and as in almost all those of 
a great number of authors, you find in their summary these 
words — many primary accidents. These primary accidents 
which have necessarilv produced the constitutional verole, are 
the chancre and the blennorrhagia. If my antagonists, by some 
reasonable motives, attached the consecutive infection rather 
to blennorrhagia than to chancre, we should have to examine 
this doctrine. But no, you know and you have read it, and you 
ought not to be much astonished, that it is together that they 
group these primitive accidents: that it is without considering 
the distance which separates their appearance one from the 
other, and that it is in giving to them all the same value, the 
same consequences and the same results. In truth, is this E 
science, is it strict observation? What should you think of a 
physician who should tell you, here is a man suffering from 
hydrophobia; he has been bitten ten times: it is three years 
since, two years, one year, six months, and very recently. But 
his disease is evidently owing to the successive inoculations 
which he has undergone. Or, here is a varioloid patient, who 


RicorcPs Letters on Syphilis. 


has gone through five or six epidemics of variola — at the last 
one the disease manifested itself; it is but the consequence of 
contagious and successive infections. 

I confess that it is not thus that I understand science. I am 
astonished that a mind as strict as that of M. Martins, who 
agrees with me that blennorrhagia is due to causes entirely for- 
eign to syphilis; who logically is forced to admit that the blen- 
norrhagic antecedents as causes of syphilis are extremely rare, 
and that the chancre consequently is the most frequent antece- 
dent of the verole — lam astonished, I say, that in order to 
arrive at the conclusion that a simple blennorrhagia can pro- 
duce syphilis, he is content with his sixty observations, of which 
he chooses three, and particularly one, which I ought to bring 
forward here. 

"An apothecary, aged 23 years, contracts a blennorrhagia, 
but it troubles him so little that he continues at his occupa- 
tions. He goes hunting, and even has sexual intercourse. 
Then follows an orchitis, which forces him to take care of him- 
self. The blennorrhagia is cured, after having lasted six 
months. Seven years afterwards, an ulceration appeal's at the 
opening of the left nostril, another one at the internal surface of 
the lower lip. These ulcerations extend ; the two lips are at- 
tacked upon the entire left side, then they are partially cured, 
and ulcerations follow at other points. The ulcerations have 
rounded bord&rs, and are cut perpendicularly : the cicatrices 
are delicate, rosy and pliable. The patient, admitted into the 
wards of M. Biett, is cured in a month by the use of the proto- 
iodide of mercury. Shall we say that this patient, half physi- 
cian, who examined himself carefully, as we have seen him do 
at the hospital, had chancres without perceiving them ?"' 

Yes, certainly, I will say that that patient had very well- 
marked chancres, from the description which M. Martins gives, 
and that the patient had not recognized them, on account of 
the unusual seat which they occupied. As to the manner of 
the contagion, M. Martins will not ask me, and I shall not take 
it upon myself to point it out. He knows, however, as well as 
I, how these accidents can follow, and without seeking malice 
therein, in the exercise of the duties even of this good apothe- 

You are aware, my dear friend, that the chancres, unusual 
in their situation, and difficult to discover, are less rare than is 
thought to be the case. I cited to you an example in my last 
letter. Here are others. 

Some years ago.. M. Lustermann, professor at Yal-de-Grace, 
brought to my house a lawyer, having a tumor upon the lower 
eyelid, at the inner angle of the eye, hard, resistant, elastic, 

1853.] Ricorfs Letters on Syphilis. 1 17 

with a red granulating surface, and in process of cicatrization. 
This tumor had been alreadj Been by many physicians, and, 
if my memory Bervea me, some occulists had been consulted, 

but its nature had hern until now unknown. I was asked if it 
was connected with some venereal antecedent more or less dis- 
tant. Pushing my examination further than my brethren, I 
found the glands about the ear, those of the parotide an region, 
and the sub-maxillary, enlarged, indolent and elastic. The 
posterior cervical glands were already tumefied. The surface 
of the body wa^ covered with exanthematoiis spots proceeding 
from the best characterized syphilitic roseola ; lenticular spots 
of a dull red, leaving in some places, under the pressure of the 
finger, a tawny yellowish color; absence of fever and of pru- 

To the great astonishment of M. Lustermann, this was my 
diagnosis : Indurated chancre at the inner angle of the eye (suc- 
cessive engorgement of the glands about the ear, also of the 
parotidean and sub-maxillary) ; secondary affection ofthecer- 
mcal glands ; syphilitic roseola; precocious secondary acci- 

To the great astonishment of the patient, I said to him — It 
is two or three months, sir, more or les*, that you conveyed to 
your eye the contagious matter, which inoculated you with 
syphilis. Recovered from his surprise, the patient said to me, 
"In truth I remember having slept with a woman, and after 
certain contacts, I was seized with much itching about the eye, 
where I carried my hand, and rubbed it during a considerable 
time. It is from that mement that my eyelid has become dis- 

Is it not true, that if this gentleman had been attacked with 
a blennorrhagia, either antecedent or accompanying, it would 
have be<n to that, that the chancre of the eve and the seconda- 
ry accidents would have been attributed ; " Very well, I must 
say that the nose of M. Martin's apothecary found itself proba- 
bly in the same condition as the eye ofour lawyer. 

M. Cazenave ought to recollect the history (no longer ago 
than 1847) of a very intelligent student in medicine, in whom 
he diagnosed a constitutional syphilis (TembUe, characterized 
by a roseola without antecedents. This young man presented 
himself at the Hospital du Midi, and there we were able to 
show the existence, before all the students, which had passed 
entirely unperceived, of an indurated chancre extremely well 
mark- d upon the left cheek, and concealed under a 

thick tuft of whiskers. The sub-maxillary glands— unobjec- 
tionable witnesses — were engorged and indolent, with that 
character of resistance peculiar^ to these glandular enlarge- 

148 Ricord's Letters on Syphilis. [March, 

merits, symptomatic of indurated chancre. This ulceration, to 
which the patient had attached no importance, being revealed 
to him, he was able to state with precision the origin and the 
date of it, which agreed perfectly with the appearance of the 
secondary symptoms. 

At this same time in the wards of the Hospital was a patient 
having a chancre (primary accident) upon the sinciput. I 
showed, at my clinical lecture, a woman who had an indurated 
chancre upon the left eyebrow, with a symptomatic enlarge- 
ment of the glands about the ear, which had two months pre- 
ceded a nocturnal cephalalgia, enlargement of the posterior 
cervical glands, and a roseola. 

I should never finish, if I attempted to indicate those cases 
only which have passed under my eyes, of chancre seated in 
unaccustomed places, and which would be confounded with 
secondary accidents attributed to a blennorrhagia of shorter or 
longer standing, by observers little accustomed to accuracy. 
I have at this moment even, in the first ward of my hospital, a 
patient, affected at the same time with a simple blennorrhagia 
of the urethra (inoculation negative), and with indurated chan- 
cre of the upper lip, accompanied with an indolent enlargement 
of the submaxillary glands, concomitant affections, but inde- 
pendent one of the other. 

Here is sufficient, it appears to me, to prove to you how 
frequent and insidious are the causes of error under similar 
circumstances, and to legalize my scepticism as regards certain 

But I ought not to forget that my learned brother of Lvons 
is waiting for me with five observations which he opposes to 
my doctrines. I ought the more to return to them, as these 
five observations have sufficed to convince the strict and re- 
served mind of M. Legendre. 

First, as I have already told you, one of these observations is 
done away with, for the patient who is the subject of them had 
had previous chancres. Four cases of simple blennorrhagia 
followed by syphilis remain. But of these four cases I shall 
permit myself to do away with two, for M. Baumes did not 
practise inoculation. These cases ought, then, to enter into 
the numerous category of those blennorrhagias for which there 
has not been a strict diagnosis. One remarkable fact, which 
you will permit me to notice in passing, is, that M. Baumes, 
who is certain of having inoculated the greater portion of the 
patients who have presented themselves to him, has fallen pre- 
cisely upon two cases of syphilitic blennorrhagia, in the diag- 
nosis of which he deprived himself of the precious aid of in- 
oculation. We are then reduced to two other cases, where 


RicoroVs Letters on Syphilis. 


inoculation has been practised with a negative result, and 
which have been followed, nevertheless, by constitutional ac- 
cidents ! 

Jn one of these Cases there h question, also, of a nose, which 
again appears to me excessively suspicious. Here is the his- 
tory, reported by M. Baumes : — 

•Of the two patients inoculated, one remained at Antigu- 
aille two months. His blennorrhagia was difficult to cine . he 
had still a white discharge when he left the Hospital. He en- 
tered it again three mouths after with a syphilitic eruption, in 
red patches, copper colored, partly furfuraceous, partly scaly, 
and a rounded ulcer with a greyish ground, with perpendicular 
borders, and with an erysipelatous circumference situated in 
the left nostril. At this period the discharge did not exist. 
Th's patient had had no coitus since hid leav ng the Hospital." 

You will find here, again, a very complete description of the 
primary ulcer; and how does it happen that in presence of a 
fact so important, in the point of view of a question so litigious, 
M. Baumes did not try the inoculation of this chancre? 1 re- 
gret it sincerely, but in the absence of all strict diagnosis. I 
ought to place this nose in the same category with the nose of 
the apothecary. 

Here I am, then, face to face with one observation only of M. 
Baumes, and that the last one. My learned colleague well 
says that he inoculated from the seventh to the tenth day of 
the appearance of the discharge ; but how much time had pass- 
ed since the infecting coitus? M. Baumes knows perfectly 
well that a knowledge of this is not unimportant. He knows, 
also, as well as I, that the chancre which is ordinarily followed 
by secondary accidents, generally extends itself but little: that 
it is perfectly indolent : that its suppuration is so little, that it 
can pass unperceived. Upon all this. M. Baumes is as well 
edifi -d as myself, I am very sure. These ulcerations (to not in 
any way pit-vent a blennorrhagia from being produced, a short 
or a long time after, and it is not astonishing that the one in 
question did not furnish inoculahle pus, the chancre having ar- 
rived at the period of reparation, or having completely disap- 
peared. It is moreover necessary to suppose, that before his 
first entrance into the Hospital, or after his departure up to the 
time of his return to it. the patient had not undergone another 
contagion, and by a way which escaped the sagacity of our 

All the- ns apply equally to the observation of M. 

Lafont G'>nzy, in which secondary accidents came on after a 
blenno; rl --en inoculated without result. He 

does not say any thing of the time which separated the coitus 

n. s. — VOL. IX. no. in. 10 

150 RicortPs Letters on Syphilis. [March, 

from the manifestation of the symptoms, a period sufficiently 
long for the cicatrization or reparation of a chancre. 

It appears to me, after all this, that my colleague of Lyons, 
who maintains that the simple blennorrhagia can give rise to 
the same accidents as the chancre, can permit me to send back 
what he addressed to me, viz., " that he establishes as principle 
that which is in question, and advances an hypothesis devoid 
of strict foundations." 

Thus fall to the ground, one by one, the objections so grave 
in appearance made against my doctrine. Thus, I continue to 
believe — 

With Girtanner, "that syphilis recognizes most generally 
for cause, chancres and buboes, and that it very rarely follows 
a blennorrhea." 

With Swediaur, "that the symptoms of syphilis are rarely 
manifested after blennorrhagia." 

With M. Rayer, "that the secondary cutaneous eruptions 
with blennorrhagia are rare ; that we observe them in a much 
smaller proportion, than after superficial and deep venereal 

These opinions, as you see, agree very well with the relative 
scarcity of the chancres of the urethra with symptoms of blen- 

I could still cite many other authorities. But I have not fin- 
ished with the objections. In my next letter I shall examine 
some of another nature. 


My dear Friend, — From this fact alone, viz., that chancres 
have been submitted to a treatment called methodical, it has 
been thought that the consecutive accidents of a constitutional 
infection, which ought to be the result of chancres, could be 
attributed to a blennorrhagia which came on afterwards. M. 
Baumes pretends to prove it in one of his five observations. 
But what is a methodical treatment? What is the treatment 
upon which we can absolutely depend for neutralizing effectu- 
ally the syphilitic diathesis? For myself, I do not know of an 
infallible one. I well know that a great number of very dis- 
tinguished practitioners think that with a certain dose of mer- 
curv, administered during a given time, we ought to consider 
the patients as radically cured. And in order not to go beyond 
the limits of my hospital, I shall cite my very honorable col- 
league. M. Vidal, who has recently given out, that with one 
hundred and ten of Dupuytren's pills, neither more nor less, 
we ought to put an end to syphilis. 


Ricord's Letters on Syphilis. 


As Is, I am the mosl I man in the world. 

Nobody more than myself respects the religion of others; but 
I have the right, it appears to me. to participation in all 

their convictions, when I see every day the proof of the E 
errors into which a blind faith may conduct one. 

M. Vidal ought to have seen many patients return : and if 
this has not happened to him, let him permit me to say, that I 
a great number of those, \\ ho have not only 
taken the one hundred and ten sacramental pills, but even 120, 
150 and more, all of which has not prevented the symptoms 
from reappearing. 

1 shall no longer insist upon this point, fori shall have occa- 
sion to return to it later. What I want to establish hei 
that thos - are often deceived who have thought 

that they ought to ascribe accidents of constitutional syphilis 
to a blennprrhagia which has come on after a chancre, from 
the simple fact that the chancre which ha i preceded, had been 
submitted to a mercurial treatment. 

Here is a point more astonishing, something which will sur- 
prise your reason and baffle your logic. 

My opposers have estab ies of veroles, 

according to their origin and their source. 

Thus they admit, ami in this they are perfectly right, that 
constitutional syphilis can he transmitted by way of inheritance. 

Tin- I they have pretended proofs for this as 

tion that constitution*] syphilis can he taken (fembl . 

Th I they publish facts for the support of this 

■times no kind ofantecedent to constitutional 
syplnlis can be found, although they do not dare to ascribe it to 
the syphilis d'eml* 

They pretend that an individual under the influence of a 
syphilitic diathesis, without present manifestations, without 
apparent symptoms, can, however, under certain circumstances, 
transmit syphilis. 

They maintain that the duration of the incubation ofsyj hilis 
should be unlimited, that the man - of the c 

should appear as well after a tew day- as after a tew 

. thirty and moi 

All the- distinctions, you will fit d es- 

tablished particularly in the writings ol W : hut upon 

what • is what I in vain ask myself. I inquire 

by what | ywhal means of come, in 

ted by a const;! te this 

ise tp one of these circumstance than to another. 

Has he e ' ,\ v hilis, after early infancy — and we -hall 
hereafter see that its effects can be prolonged — a special svmp- 


Ricor(Ts Letters on Syphilis. 


tomatology ? Can constitutional syphilis. cPemblce, be distin- 
guished from the other kinds by any pathognomonic sign ? Do 
the cases of verole in which the antecedents have not been 
made out, ^ive rise to disorders different from those in other 
cases? What is a verole without antecedents, unless it is a 
verole d'emblee 1 Do we find that those cases of syphilis which 
have succeeded to simple blennorrhaon*a, assume forms less 
grave, or have less extended seats, as M. Baumes pretended to 
find in writing his hook, but which he has not been able to meet 
with in his practice? 

I answer boldly, no, to all these questions. Constitutional 
syphilis presents a symptomatology alike in all cases; and it is 
not I who prove it, it is my opposers themselves. Read again 
their writings, and see if you can find in the descriptions given 
by MM. Cazenave, Baumes, &c., one single characteristic trait 
which justifies these arbitrary distinctions. 

Again, one thing in my opponents astonishes me. How does 
it happen that in these cases of constitutional syphilis, whether 
(Vembhe or without antecedents, when it has been impossible 
for them to be assured of the conditions of the contagion — to 
state precisely the when and the how — if it is well proved that 
the patient has presented no primitive accident, they having 
found no door of entrance to the verole; when they are well 
convinced that the patient is not mistaken, and that he has no 
motive in deceiving ; when, in fine, they have the certainty of 
not being themselves deceived; I am astonished, I say, that 
they do not admit what Cullerier admitted to explain the inex- 
plicable cases, viz., spontaneous syphilis in man. 

M. Richard des Brus has made this great step. Among 
other facts which brought him to this conviction, he cites one 
which is very curious. A young man and a young woman 
yield themselves to the pleasures of love. Jn his ardor the 
younuj man scratches himself with a hair of his mistress. He 
does not stop for such a trifle, and he does so well, that he 
communicates his ecorchure to his mistress. The amorous 
couple are soon simultaneously affected with constitutional 
verole. M. des Brus, who had examined neither of them, did 
not the less admit a previous good state of health ; but not be- 
ing able to explain the appearance of the verole, he declares it 

I am not as far advanced as this learned colleague, and the 
so frequent opportunities that I have of seeing constitutional 
affection succeed to a well-determined primitive accident, 
causes me to rank the exceptional cases, where the patient does 
not know or does not wish to enlighten me, and those in which 
I arrive too late to find the entrance of the syphilis, in the cate- 

1853.] Ri cord's Letter* on Syphilis. 153 

gory of observations which M. Cazenave entitles unknown 
antecedent^ and which I call overlooked. Alas! is it not more 
satisfactory for the mind, more conformable to our manner of 
reasoning in medicine, to admit in those cases where syphilis 

has really succeeded to a biennorrhagia not symptomatic of 
chancre, that the antecedent has not been recognized, rather 
than to lose one's self in that ciowd of subtile distinctions, of 
arbitrary categories, and of sterile explanations? How, other- 
wise, will my contradictors undertake to prove to me what 
they say, and to convince me of error? It is not my habit to 
challenge any one ; this sort ol argument ought to be banished 
from scientific discussions; but I much wish that they would 
_e to prove to me once only, yea, once, that, in those cases 
where all my researches having been vain I have said antece- 
dent* overlooked — that they would prove to me, that something 
more affirmative could be substituted for this formula. 

From this long discussion, my dear friend, it will appear to 
you without doubt legitimate to conclude — that if in tins im- 
mense majority of cases, biennorrhagia is simple and benign, 
there exists also a virulent biennorrhagia; and that the bien- 
norrhagia is virulent when there exists a concealed chancre in 
the urethra. 

N w does the means of making the diagnosis of concealed 
chancre exist ? 

Is it possible to distinguish a simple biennorrhagia from a 
biennorrhagia with concealed chancre ? 

Here is the grand question. 1 commence the discussion of it. 

Some persons have made light of the diagnosis of blennor- 
rhagia. Hecker, and some others who have followed htm, 
have not thought that the diagnosis was necessary. Very re- 
cently 1 read in your valuable Journal that the diagnosis had 
no relative importance. A certain number of physicians have 
retained ideas which have been in vogue, and which ougfit 
much to astonish the public. 

Have you caught biennorrhagia from a wife who was not 
yours? Virulent biennorrhagia. The biennorrhagia is viru- 
lent for the lover, tor the husband it is benign. You have con- 
tracted a biennorrhagia, and you ought to remain bachelor. 
Simple treatment. But you wish to marry. Antisyphilitic 
treatment. The position of bachelor, or ot future husband, has 
the privilege of causing the biennorrhagia to pass from the be- 
nign state into a virulent state. 

In a question as seiious and as important ns tin's, I do not 
wish to insist upon the ridiculousness of these contradictions. 
All have understood the necessity of a more Strict diagnosis. 
The latest of my opponents, M. Vidal himself, with whom my 

154 Quinine in Tetanus. [March, 

proceedings in diognosis have not found favor, has made some 
attempts in this matter. In the first edition of his Treatise upon 
External Pathology, he gave out the hope that it would be pos- 
sible to distinguish a virulent discharge from a benign one, by 
the odor. This appears, and it is to be regretted that his hopes 
were not realized, for this passage disappears in the second 

I hold rather more to my ideas than M. Vidal appears to hold 
to his. Will you, then, permit me to give out once more, both 
my ideas and my experience upon the diagnosis of blennorrha- 
gia, and to examine the objections which have been made to 

But I cannot treat of this subject in the short space which 
remains for me, not wishing to abuse to-day the generous hos- 
pitality which you afford my letters. This point will be the 
subject of my next epistle. — [Boston Med. and Su?*g. Journal. 

On the use of Quinine in Tetanies. By E. A. Pye, M. D., of 


In the spring of 1850, Dr. N , a retired physician of 

Catahoula parish — a gentleman of intelligence and information 
— called on me to know "if I had seen any thing, in the course 
of my late reading, worthy of a trial in Tetanus." He had a 
negro boy, about 14 years old, laboring under the most violent 
attack of Traumatic Tetanus that he ever witnessed. The 
boy had fallen from a horse some weeks before, receiving a 
wound in the face. The wound was apparently slight ; little 
attention was paid to it, and it healed in the usual time. Symp- 
toms of Tetanus, however, soon made their appearance, and 
had gone on constantly from bad to worse, in spite of the treat- 
ment. He had been purged, blistered, had taken opium, whis- 
key, spirits turpentine, calomel, the hot and cold bath, but with 
no relief. "In short," said the Doctor, I have gone through 
the routine. I have tried the old practice; unless something 
else can be done the boy must die.'' I recollected that in the 
New Orleans Medical and Surgical Journal for 1849 I had no- 
ticed a case, reported by Dr. Brickell, of the Charity Hospital, 
in which chloroform and quinine had been given, and in which 
the cure was attributed to quinine, in 30 grain doses. It seem- 
ed to me, at least, worthy of a trial — the quinine.* The sug- 

♦ Note.— [A case of Tetanus treated successfully in 1848, with quinine and 
morphine, was reported by us in the 6th vol., p. 340, of the Southern Med. & 
Surg. Jour.— [Edt. 

1853.] Quinine in Tetanus. IJMj 

gestion was at once adopted. We decided to begin with 30 
or 40 grains, and increase the dose until some effects were 

produced. The Doctor was rather doubtful of finding his 

patient alive on his return; but promised, it' hi; was still living, 
to give the quinine a fair chance. On his return he found all 
the symptoms increased in intensity. The intervals between 
the paroxysms had dwindled to but a few moments of partial 
ease; with these transient*exceptions, he was in a state of con- 
stant and most violent opisthotonos: and it was evident that 
unless relief could be procured, death must soon close the ter- 
rible scene. Taking advantage of the first opportunity, the 
Doctor got down his throat 30 grains of quinine — examining 
his watch at the same time. In one hour he again visited him 
— he could perceive no change; repeated the dose. In the 
course of the next two hours the Doctor thought or fancied he 
perceived slight — the slightest possible diminution in the in- 
tensity of the paroxysms; at any rate the hoy thought himself 
relieved, and begged for the medicine. He got 30 or 40 grs. 
The improvement in the next two hours was evident. The 
paroxysms were not only less severe, but the interval was also 
decidedly longer and freer from pain. The boy's sensation of 
relief was yet more decided, and he clutched at his quinine 
and swallowed it with an evident "gusto." He threw his 
arms heavily about, saying that he felt '' drunk " and " happv !" 
The case went on regularly improving; the only other medi- 
cine given being an occasional dose of oil, to keep the bowels 

At the end of two weeks I met the Doctor. The boy had 
taken two ounces of quinine ; was entirely free from all symp- 
toms of Tetanus ; had experienced no bad effects from this 
enormous quantity of quinine ; no tinnitus aurium — deafness — 
fulness of the head. The muscles had become relaxed, the 
skin was acting finely, the bowels were free. The only pecu- 
liar effect of the quinine beinfj the one mentioned above, which 
he frequently expressed — the feeling as if he were about half 
drunk or "happy." Here a prudential regard for the "man 
with the poker/' or some other analogous event, from the sud- 
den withdrawal of an agent, whatever its modus operandi, 
which had kept our patient "happy*' for two weeks, despite 
of Tetanus, induced us to taper off': which we accordingly did, 
giving him about halt' an ounce of quinine, in gradually dimin- 
ished d. >>••<. in the course of the following two weeks. 

I saw him at the end of this time. well, fat and hearty. The 

►r promised to give me ihe notes ol tin- case, which would 

have rendered it more satisfactory. Circumstances having 

prevented my getting them, I have thought it might not be 

156 Substitute for Ergot. [March, 

altogether without interest as it is. In this age of heroic doses 
of quinine, the writer records his wholesale administration of 
the drug with much diffidence. He not only disclaims the un- 
hallowed ambition of ''out Hemding Herod," in this regard, 
but deprecates truly, on the contrary, the "spirit of enormous 
dosing" so rife through the land. One may, however, some- 
times rind himself so situated that the maxim "occasio praeceps" 
must stand in the place to him of all precedent. In the pre- 
sent instance, the result of treatment, the circumstances of the 
ca<e, the character of the gentleman by whom the medicine 
was administered — all combine to assure the writer that the 
practice, I hough seemingly ultra, was in reality only so much 
so as the occasion demanded. 

Watson says there is no cure for Telanus. Perhaps he is 
right ; but Dr. Brickell records a case in which unequivocal 
symptoms of the disease yielded to quinine. I give you my 
facts for what they are worth. Let others contribute. "Ex 
multis Veritas." — \_N. O. Med. Journ. 

A Valuable Substitute for Ergot. By B. H. Washington, 
of Wood burn, Kentucky. 

I lately attended a midwifery case, and deem it advisable to 
report the treatment for further investigation. The pains com- 
menced at 4 A. ML, and continued at intervals of J 5 to 20 
minutes, until 6 P.M.; were slight, and produced but little 
effect. Upon examination, found os uteri dilated ; head pre- 
senting, but high up; scarcely any effect perceptible during 
the pain. Not willing to leave the management of the case 
any longer. to nature, I concluded to dry-cup her; applied a 
cup as low down on the sacrum as possible so as to cover the 
origin' of the nerves to the os uteri and produce relaxation. Pre- 
vious experiments had shown me the uterus would not contract 
unless applied higher up. My design was to produce relaxa- 
tion of the os uteri, and then dry-cup higher up, so as to cause 
the uterus to contract. The result was most satisfactory to all 
interested, for complete relaxation ensued ; at the next pain 
the head descended to the outlet, and at the second pain she was 
safelv delivered, and that too in less than, ten minutes from the 
application of the cup. No hemorrhage resulted ; the placenta 
came away with scarcely any inconvenience in about three- 
quarters of an hour, and every thing went on well. 

This is the second case in which the above plan has been 
tried: in the first, the patient was safely delivered in about 15 
minutes, and with three pains. She had been suffering upwards 

1853.] Substitute for Er 157 

of twelve hours, without effect ; was induced to try the plan 
from two facia — first, the partial paralysis of the arms while the 
cup was over the origin of the brachial nerves, and the suc- 
cessful application of dry-cupping in a case of dislocated 
shoulder joint, as mentioned in my first article on dry-cupping ; 
secondly, the cups had been sppliecj on a patient after delivery, 
to relieve the disagreeable feelings resulting therefrom, and the 
patient told me she could feel the uterus contracting very 
Btrongly. Putting these tacts together, it occurred to me that 
>n traction was the legitimate function of the uterus, while 
expansion was the legitimate function of the os uteri, by the 
application of the cups over the origin of the nerves to t he de- 
fective parts, the appropriate results would follow. The plan 
ha- been followed with the most complete success, as manifest- 
ed by the cases above mentioned. I would therefore recom- 
mend atrial of it in all tedious cases. Apply, first, a cup as 
low down on the sacrum as possible, and if in the course of 
ten or fifteen minutes the patient was not delivered I would 
recommend the application of another cup higher up, so as to 
cause the uterus to contract ; the lower one should always be on 
when the upper one is applied, so as to insure relaxation ot the 
os uteri when the pains come on. 

Jn cases of retained placenta, I would recommend a contrary 
course: apply the cups higher up, so as to cause the uterus to 
contract at once ; the placenta can always follow the child. 

The great advantage of this method of causing the os uteri 
to relax and the uterus to contract, over the plan of giving 
ergot, needs no other recommendation, I presume, than a simple 
statement of facts : — When ergot is administered, the woman 
is delivered by main force and in opposition to the usual pro- 
ceeding of nature, without any relaxation except that produced 
by the most fearful and agonizing pains — by dry cupping such 
a complete relaxation is produced, that two or three pains are 
sufficient and the amount of suffering is not more than ordina- 
ry. Indeed, the amount of suffering is so much lessened, one 
would feel tempted to try it in ordinary cases, where every 
thing was going on well, merely to shorten the period of suffer- 
ing. Another advantage is, that as soon as the delivery is 
the pams are over too; the placenta comes away with scarce- 
ly any inconvenience. Whether it would be justifiable to 
apply it in an early staire of labor, merely to lessen the dura- 
tion of suffering. I leave to be decided by future experience. I 
certainly should not recommend it at th without further 

trial. In my first article on dry-cupping, 1 omitted two im- 
portant items — first, that it breaks up the chain ofnerv-ais 
sympathy during pregnancy, and, regularly applied, h 

158 Treatment of Still-born Children. [March, 

broken ; the patient suffers very little, and that little more from 
imprudence than from nervous sympathy. Let the patient be 
dry-cupped every third or fourth night, (her husband can easily 
do it with a tumbler,) and sponge herself two or three times a 
week with water, cold or warm, according to fancy, and my 
word for it she will suffer as little as the heartiest Indian fe- 
male, unless broken down by some organic disease. The other 
item is, that if there is a scant secretion of milk, or none at all, 
apply three or four cups to the spine, especially over the origin 
of the mammary nerves, and there will soon be a plentiful 
supply. These items are not theoretical assumptions, but the 
result of actual practice, and I sometimes censure myself for 
not making them public sooner, as an immense amount of sym- 
pathetic suffering can be easily prevented. As mentioned in 
my first article, when it is desirable to produce an effect on a 
given part, the cups should be more strongly applied over the 
origin of the nerves distributed to that part; and they should 
be larger than those in common use ; a common tumbler with 
a thick rim will answer very well, except in female cases; in 
those I use the pump to produce a vacuum, as they can be ap- 
plied under the covering without offending the most fastidi- 
ous. — [Nashville Journ. of Med. and Surg. 

New Method of Treating Still-born Children. By T. Wood, 

M. D.. of Cincinnati, Ohio. 

Mrs. C was brought to bed in her first confinement, 

and had a very protracted and tedious labor, from a rigid and 
unyielding vulva. The child on delivery was in a state of syn- 
cope, so profound as to leave but little hopes for restoration to 
life. Full five minutes had been lost in fruitless efforts to excite 
breathing, and the only sign of life in the child was a slight con- 
vulsive effort while its lower limbs were yet in the vagina, after 
which it lay flaccid, ex-sanguineous, and in appearance dead. 
Cold air, cold water, and brandy had been thrown on its chest 
without producing the slightest effect, and I was about to inflate 
its lungs, when I noticed that the vessels of the cord were much 
distended with blood, and a very feeble pulsation in its arteries. 
Finding this condition of the cord, suggested the idea that, 
perhaps, if the blood it contained could be forced into the circu- 
lation of the child, it might afford the required stimulation. 
Instantly acting on the suggestion, I took the cord between my 
thumb and fingers, and drew its whole length between them, 
so as to force the blood into the child, when it immediately 
cried lustily, and animation was completely restored. It had 
no more difficulty in beginning life, and is now doing well. 

1853.] Tapping in Hydrocephalus, 159 

I report this case under the impression that this mode of 
treatment is original. 

Since having ihe above case, I tried the Bame treatment in a 
child that was delivered by a long labor, embarrassed by con- 
vulsions. Animation was at once restored on forcing the 
blood from the cord into t he circulation of the child, but there 
was not, previous to resorting to this means, such complete 
prostration of the child as in the first case, and though effectual, 
the result was not bo striking. 

My friend, Dr A. M. Slocum, informs me that since I rela- 
ted my case to him. he has tried it in a similar prostration of 
the child, with the same happy result. — [Western Lancet. 

Tapping in Hydrocephalus. 

The intractable nature of chronic Hydrocephalus is such as 
to warrant, in some cases, a resort to tapping; for, although 
this operation has usually proved ultimately unsuccessful, it has 
repeatedly prolonged life, and may yet be so regulated as to give 
permanent relief. In 183G we tapped a child's head seven differ- 
ent times, drawing off sixty-three ounces of fluid without the 
slightest unpleasant effect — yet the child died, apparently from 
inattention on the part of the mother to directions. This case 
was reported in the first volume of this Journal, (old series.) 
1836, p. 440. 

The following is an extract from a case reported in the 
Transylvania Medical Journal, by M. Howard, M/D., of Lou- 
isville.— [Ed. S.M.&S.J1. 

"The head went on enlarging until it attained an extraor- 
dinary size — measuring 23 inches in circumference and 14 
inches in a vertical direction, from one auricular orifice to the 
other. The pressure of the accumulated serum at length pro- 
duced total blindness, and a partial paralysis of the mus 
The face became contorted, and the extremities hung flaccid 
and motionless. 

m It now became apparent that the little sufferer was reduced 
to great extremity. I abandoned all hope of relieving it with 
the aid of mere pharmaceutical agents, and intimated to its 
parents that I was willing to give up the 
one. On being urged to further effort, 1 pr the opera- 

tion of puncturing the membra . dernier resort, at the 

same time warning the family that I had but little faith in its 
efficacy. The pressure of the enormous accumulation of se- 

160 Tapping in Hydrocephalus. [March, 

rosity on the extended memhranes and the brain, induced an 
intolerable amount of suffering, which was indicated by the 
constant moaning and restlessness of the child, even in sleep. 
This painful pressure I could alleviate by decanting off a por- 
tion of the fluid, but it was at the risk of accelerating the final 
issue — death. I frankly stated this fact, and warned the fami- 
ly that the operation, though simple, was hazardous; that death 
might possibly ensue at once, and that the possibility of its ef- 
fecting a radical cure was too remote to afford much ground 
for hope — the only certain recommendation in its favor being 
that it would effect a temporary remission of the suffering, if 
the patient survived it. Notwithstanding these representa- 
tions, the child's father urged the performance of the operation. 
The mother, however, had conscientious scruples ; he was, 
therefore, induced to defer submitting his child to the risk, un- 
til the sanction of a clergyman (the relative of the child before 
alluded to) could be obtained. 

"In the mean time I had prepared a close-fitting cap of gum 
elastic, which I purposed to use, to maintain an equal pressure 
during the evacuation of the serum. I also obtained a minute 
trocar and canula, the blade of the trocar not being longer than 
the ordinary couching needle. 

"Experience has taught us, that the principal danger to be 
apprehended in puncturing the head for cerebral dropsy, is the 
production of fatal syncope, from the sudden removal of pres- 
sure from the brain and its appendages. I therefore had stimu- 
lants at hand, and determined to decant the water slowly, 
watching narrowly, in the mean time, its effect on the pulse. 

" The trocar was introduced carefully, a little to the right of 
the inferior angle of the fontanelle, in a perpendicular direction, 
to avoid the longitudinal sinus. The depth to which the in- 
strument penetrated before the fluid was reached, seemed to 
favor the belief that the convolutions of the brain had been 
unfolded by the pressure of the fluid, and lay in a thin layer 
immediately in contact with the membranes. 

" Some high European authorities have denounced this opera- 
tion as cruel and worse than useless. But the result in (his 
case does not sustain this \iew. The patient suffered very 
little from the introduction of the instrument, and apparently 
none at all afterwards. Upon the withdrawal of the trocar, 
the water was forced for a moment in a violent little stream 
for several feet, owing to the pressure of the tense membranes. 
I allowed it to flow freely fov several minutes, no symptoms of 
exhaustion supervening until about twelve ounces had been 
withdrawn. Immediately after the operation the patient sunk 
into a profound and tranquil slumber, from which she awoke 
in about five hours, apparently much refreshed. 

1853.] Wry Neck cured without Cutting. 16] 

"The most important result of the first tapping was tl. 
moral of the paralysis. The countenance regain* d its natural 
expression, and the muscles of the limbs appeared to have be- 
come more subject to volition. 

'• To aid the effect of the tapping, I renewed the eonnter irri- 
tation, and the exhibition of alterative m days 
after the first tapping, I drew off about eight ounces of v. 
After the second operation, long slips of adhesive plaster were 
1 around the head in various dii ipport the 
s, and to assist the action of the elastic bandage. The 
little patient now appeared to be progressing finefy. The head 
was diminished considerably in size, her appetiteand command 
of muscle appeared to increase, and, better than all, the retina 
appeared to be regaining its sensibility. Previous to the first 
operation she was totally blind, and the muscles of the eyes ap- 
peared to work without concert. Strabismus divergens, and 
convergens, had occurred at irregular intervals: but now the 
movement of the eye-balls obeyed the will, and the nerves ap- 
peared to have become sensible of external impressions, though 
the sight was far from being perfect. These happy results en- 
couraged me to attempt too much on the third operation. I 
decanted the serum a little too rapidly, and the patient sunk 
into profound syncope, from which she was restored with 
difficulty. No untoward consequence ensued, but the mother 
of the child became so terribiy alarmed at the effects of the 
last tapping, that she refused to allow its repetition. In her 
opinion, the object in view would not have justified the result, 
if her child had died from the effects of the operation. 

" I had the satisfaction of finding, however, that no further 
effusion took place. The head was much reduced in size, and 
did not subsequently enlarge. She gradually gained a pel 
control of the voluntary muscles, and her sufferings from the 
serous accumulation appeared to be entirely removed, so that 
she became even playful. Several months after I had removed 
from the county. I learned from Dr. William Dunham that the 
child had died from an attack of typhoid fever, (typhoid pneu- 
monia, I think.) Up to the time of her last illness no change 
for the worse had taken place in her condition." 

Wry Neck Cured without Cutting. By to T. D., 

, to New York Hospital. 

The success obtained in the t itortion of 

the Head, commonly known as Wry Neck, induces the wri- 
ter to make them known to the profession, in order that the 
treatment employed, which it is believed haa not hitherto been 

162 Wry Neck cured without Cutting. [March, 

applied in such case r ; may be fully subjected to the test of ex- 
perience : 

Case I. Hester Higgins. a native of Ireland, aged 25 years, 
unmarried, was admitted into the New York Hospital on the 
6th Nov. 1848, at which time she had suffered from rheuma- 
tism already about seven months ; all the larger joints of the 
body having been sufficiently affected. About four months 
prior to her admission, she suffered a relapse, after having nearly 
recovered, and since then she has experienced but little allevi- 
ation of her ailments. Her neck as well as most of her larger 
joints are painful, though not much swollen. Her tongue is 
slightly furred, her pulse is 85 and soft ; her skin moist, and 
bowels regular. 

On the 19th of January following, she had nearly recovered 
from her rheumatism, under treatment, except rigidity and con- 
traction of the muscles of the right side of the neck, by which 
the head was drawn downwards and towards the right shoulder. 
To relieve this distortion, frictions with stimulating and oleagi- 
nous liniments were diligently employed, and, subsequently, 
sulphuric ether was applied to the neck. Some slight improve- 
ment resulted from the use of these means. On the 18th of 
April, however, the condition of the neck had for some time 
been stationary, and all hope of further benefit was abandoned. 
The motions of the head were very much restricted, and any 
attempt to overcome the resistance of the rigid muscles by 
stretching them occasioned severe pain. The rigidity did not 
appear to reside in the sterno-mastoid muscle, inasmuch as this 
muscle did not grow hard and stiff when efforts were made to 
elevate the head ; the resistance was evidently seated in the 
deeper muscular and tendinous parts. 

At the request of my colleague, Dr. Swett, of the Medical 
Division, I saw this patient and proposed to make cautious 
attempts to overcome the resistance by force, the patient being 
first subjected to the influence of sulphuric ether. Considering 
the resistance to depend on contracted muscular and tendinous 
fibres, my object was either to stretch or rupture them, and in 
doing this, no danger was apprehended to the important nerves 
and blood-vessels of the neck ; since the forced movement ne- 
cessary to accomplish this object would fall far short of the 
extensive motions in every direction to which these parts are 
accustomed naturally to accommodate themselves. 

Dr. Swett assenting to my proposal, the patient was laid 
upon her back in bed, with her head resting high up on a pil- 
low, so as to be easily got at from the head of the bed. Taking 
the head between my two hands placed one on either side, I 
cautiously stretched it with a very moderate degree of force in 

1853.] Wry Neck cured without Cutting. 103 

the direction opposite to that in which it waa distorted, tl 
upwards and to the lefl side. Almost immediately every one 
standing round the bed (of whom there were at least eight or 
ten pupils and medical men), was startled by a loud snapping 

sound ofsome thing rupturing, and at the same time I perceiv- 
ed that the head yielded, and could he brought almost to its 
natural position. It was thought prudenl to proceed no further 
at this operation. The patient on recovering her consciou 
was not sensible of any new soreness in the parts, and could 
bear the head to be moved much easier than before the oper- 
ation. She was directed to lie as much as possible on her left 
side. On the following day there was considerable soreness 
on the right side of the neck. On the 25th of April, one week 
after the first operation, the soreness of the neck having very- 
much diminished, the operation was repeated a second time. 

The proceedings were thesame as in the first operation, only 
the stretching was carried to a much greater extent, and with 
a much less timid hand. Several times resisting fibres were 
felt to yield with a rupturing sensation, till, at length, no further 
nice was encountered, and the head could be carried to 
the full extent in every direction. After the effects of the ether 
had passed of]', the head was bandaged down towards the left 
shoulder. On the first of May, the bandage being dispensed 
with, the head showed no disposition to resume its distorted 
attitude. On the 10th of May (1S49), the head could maintain 
unaided its erect natural position, though rotation and flexion 
were still limited in extent, and performed awkwardly; the 
patient, however, was sensible of the progressive improvement 
in these respects. She took her discharge from the hospital 
for the purpose of returning to her friends in Ireland. About 
one year afterwards she was heard from as continuing well, 
and free from any distortion or rigidity of the neck 

Gasp, II. In January, 1852, Maria P , of Guilford, Con- 
necticut, aged 12 years, and of a healthv constitution, came 
under my care, with the head very much distorted from being 
drawn down towards the chest, with the face turned to the left 
side. The motions of the head were also very much restricted. 
In the month of July preceding, she had been attacked with 
sore throat and still' neck, that left her ever since in the condi- 
tion just described. Slit' had never suffered from rheumatism 
in any other part of her body, and had generally enjoyed good 
health. I at once decided to employ the treatment which had 
been so successful in the preceding and on the 15th of 
January, having first etherized my patient, I performed the first 
operation. In order to carry the extension of the head to the 
requisite degree, it became necessary to have her supported in 

164 Wry Neck cured without Cutting. [March, 

the sitting posture in a chair, and to place myself in front of 
her. Grasping the head between my hands, I acted on it in the 
various directions in which resistance was encountered, but 
felt no sensation of rupturing fibres, in this or in any of the 
subsequent operations. The resisting parts, however, yielded 
in some measure, and allowed the head to be brought more 
nearly into its natural position. No pain was experienced 
from the operation on recovering her consciousness. 

On the 19th, no effect was observable from the first opera- 
tion ; it was therefore repeated a second time, with the aid of 
ether. On the 24th, 26th and 30th of January, and on the 
4th and 7th of February, it was also repeated, each time with 
the aid of ether. Though a gradual improvement was percep- 
tible from these repeated operations,- it became evident that a 
complete cure could only be achieved by a patient and perse- 
vering repetition of them for a long time; it was therefore 
judged most prudent to continue the operations without the 
aid of ether. The patient's courage and endurance, though 
put to a severe test, proved adequate to the trial. Once every 
day she submitted with the most admirable fortitude to the 
stretching process, for about ten minutes each time. This was 
continued up to the 1st of March, after which it was repeated 
twice every day. The manner of manipulating was as follows: 
The patient was seated in a chair, and her body steadied by an 
assistant standing behind her and holding her shoulders firmly 
with both hands. Placing myself in front of her, I grasped her 
head with my hands in such a way as to perform most efficiently 
the different movements 1 wished to execute. These move- 
ments were varied in every direction in which resistance was 
encountered, my object being to stretch to the utmost the con- 
tracted muscles, and to maintain them on a stretch for a certain 
length of time. The process was painful only during its actual 
performance, and ceased to be so the moment it was discontin- 
ued. On the 24th of March, the operations were suspended, 
while the patient made a visit to her family, and were resumed 
again on the 8th of April. During this interval no relapse took 
place. The same course of treatment was continued till the 
10th of May, when she returned to her home, highly gratified 
at being able to maintain her head by her own efforts in its 
natural erect position, and to turn it in different directions al- 
most as well as ever she could. She was advised to continue 
for a teng time the daily practice of performing the various 
motions of the head as extensively as possible. On the 13th 
of January, 1853, J conversed with an aunt of my patient, who 
had recently visited her, and who reports that she holds her 
head in a very natural manner, and can move it at pleasure 

1853.] New Operation, $c. 165 

freely in every direction. In ;i word, isiders herself 

quite well again, and without any disposition to rela; 

[New York Medical Times. 

Mr. Bowman's New Operation for the Division and Removal 
of False Membrane or Opaque Capsule from the cutis of 

A new and very simple method of effecting the above object 
has been recently introduced by Mr. Bowman, and been attend- 
ed with complete success. It is well known how tou<;h and 
resisting these bands and portions of membrane often prove, so 
that a cutting needle fails to divide or tear them, thopgh it may 
drag them from one side of the pupil to the other, the structure 
yielding to a certain extent, and then returning to its place on 
the withdrawal of the instrument. The iris and ciliary body 
to which these membranes are usually attached, are liable to be 
stretched and injured under such handling, and we have even 
seen the iris detached from its ciliary connexions; serious in- 
ilammation is also prone to follow the operation. 

The peculiarity of Mr. Bowman's method consists in the use 
of two ordinary cataract needles simultaneously. They are 
introduced through different points in the cornea down to the 
band of membrane, and their points having entered it at the 
same or neighboring situations, as convenient, are then separa- 
ted, tearing it across, and carrying it in two fragments to oppo- 
site sides of the pupil. Thus there is no drag put upon the 
vascular parts, and the only tissues touched are the cornea and 
the opaque membrane itself. One needle may be made to fur- 
nish a fixed point of resistance from which the other can act 
with advantage. During the last ten days this method of oper- 
ating has been successfullv adopted in seven instances, three of 
them were cases in which, after the removal of the lens by dril- 
ling, the pupil still continued closed by false membrane ; and in 
the other four the sight was more or less interfered with by 
bands of lymph or tough opaque capsule passing across the 
axis«of vision behind the iris. — [Western Lancet. 

Escalier'b Proceeding in Asphyxia from the Inhalation of 

Professor Rigaud relates in the Ahrillc Medicate of Xov. 3d, 
1851, the following case : — 

months ago I was going to operate upon a woman for a 
tumor in her breast, and caused her to take chloroform. After 
a few inspirations the pulsation ceased suddenly, and the pa- 

n. s. — VOL. IX. NO. III. 11 

166 Effects of the Vapor of Oil of Turpentine. [March, 

tient gave no sign of life. The chloroform was immediately 
removed, cold water thrown into the face of the woman, and 
frictions made over various parts of her body. After two min- 
utes, which seemed so many long hours, these manoeuvres pro- 
duced a few feeble contractions of the heart, which soon ceased 
again, and were not accompanied by a single appearance of 
respiration. In this fatal condition it occurred to me to resort 
to the treatment of Dr. Escalier. I introduced my right index 
finger into the mouth of the asphyxied patient, made it pass 
along the base of the tongue, and lift the epiglotis. Then I 
pulled the tongue out of her mouth. This rapid motion caused 
an inspiration, which I made use of to let her inhale Ammonia. 
But as soon as I let go the tongue it slipped back, and the res- 
piration ceased again. I repeated the same manoeuvre, and 
produced arrain respiration. But this time I retained the tongue 
outside of the mouth, and respiration continued to go on ; after 
which, the woman recovered very soon, and all functions re- 
sumed their normal actions. Then I made the intended opera- 
tion, without chloroform, and every thing went perfectly well. 
I have no doubt, that in this case, the life was saved by the 
treatment recommended by Dr. Escalier. — [Ibid. 

The Effects of the Oil of Turpentine on Persons exposed to its 
Vapor. By Elisha Harris, M. D., Physician to the N. Y. 
City Dispensary. 

During the past few years there have come under my obser- 
vation and care, several interesting cases of strangury, hema- 
turia, &c, resulting from continued exposure to the vapor of 
the oil of turpentine. Some points of interest connected with 
the history of these cases, may justify the following brief ac- 
count of them. 

Case. A laborer employed in unlading a cargo of turpen- 
tine, began to suffer from vesical irritation and dysuria, at the 
c'iose of his second day's labor in the ship; and at the end of 
the third day, when he applied to me for relief, he presented all 
the symptoms of acute inflammation of the bladder. •The 
urinary organs were in a state of excessive irritation; there 
were almost constant efforts of micturition, with the passage of 
but a few drops of bloody urine— or more frequently, of blood 
onlv. The patient complained of severe pain in his back and 
loins, and he suffered from nausea, vertigo, and impaired vision. 

The poor fellow had no idea of the true cause of his suffer- 
ings, but was confident that he had been maliciously poisoned. 
Upon inquiring, I learned the nature of my patient's employ- 
ment, and advised him to desist from his labors in the ship. I 

1853.] Effects of the Vapor of Oil of Turpentine. 107 

prescribed copious draughts of nd demulcent 

drink, a tepid batn, Air. In th of forty-eight hours he 

had fully recovered. Immediately after (his, there occurred 
io the Bame ship three similar cases. 

By inquiry, I have since learned that the occurrence of such 
on board of vessels freighted with turpentine, and also 
among laborers employed in unlading such cargoes, is no un- 
frequeqt event in warm weather. The late Dr. F. P. Colton 
reported an interesting case that came under Ins care in the 
N. Y. Hospital. (Vide Cotton's X. Y. Hospital Cases. N. 
York Jour. Med., Vol. V.. No. 3.) 

ently I have had occasion to treat several cases of stran- 
gury, hematuria, eczema, ovaritis, &c, occurring fn an 
whose lobors expose them to the vapor of turpentine. They 
I in an extensive manufactory of India Ruhher 
s, where camphene is used as the solvent of ihe gum 
caoutchouc. Two of these patients were young females, and 
in them turpentine seemed to have induced very grave consti- 
tutional irritation. Long continued insomnia and malaise had 
induced a state of nervous and mental irritability borderii 
mania, and almost characteristic of the difficulty. During the 
lirst three months that these girls W re employed in the facto- 
ry, they suffered from dysmenorrhea and menorrhagia ; and 
quently, at the time they came under my care, they suf- 
fered !rom ovaritis and kucorrhcea, all oi which had und 
ediy been caused by the terebinthine vapor which they were 
obliged to respire, while in thedischarge of their duties. The 
bodies of both these patients were extensively covered withan 
eczematous eruption, which soon disappeared, with all the 
other unpleasant effects of the turpentine, on their leaving the 

One of the young men employed in this factory, suffered a 
higher deizree of irritation of the urinary organs than 1 ever 
before wil After repeated attempts t<> continue at his 

labors in the factory, he was obliged, ultimately, to leave t lie 

The interest excited by those cases has led me to make in- 
quiries, in reference to the prevalence <>\ the irritating and 
ious etlects of turpentine among artisans who are exposed 
to its v;i 

The intelligent conductor of an extensive manufactory of 
India Rubber goods in this city, informs me that about two 
thirds "t ;i!l his employees suffer considerable vesical irritation, 
jury, vertigo, mm- . & . during the first few months of 
their employment in the factory, and that after a time they 
nearly all become bo that the terebinthine air no 

168 Effects of the Vapor of Oil of Turpentine. [March, 

longer affecls them. In this establishment it # is the practice of 
those who suffer from the effects of the turpentine, to take large 
and frequent doses of olive oil. 

In the India Rubber factories of New Jersey, where cam- 
phene is used as the solvent of the caoutchouc, the same facts 
are observed as in this city. 

In an extensive manufactory in New England, in which 
camphene is no longer used, I learn that when the terebinthine 
preparations were used, the workmen suffered very much. In 
this establishment the workmen were in the habit of antici- 
pating the effects of the terebinthine vapor, by subjecting them- 
selves to a process of "seasoning." by taking repeated doses of 
camphene. In this and other manufactories, I find that females 
do not seem to have suffered as much as males from the pecu- 
liar local effects of the turpentine, but they have suffered much 
more from its effects upon the nervous system and the skin. 

In connection with this subject, I would record a case in 
which a large quantity of camphene was swallowed by a child, 
with almost fatal consequences. 

D. H., a boy aged three years, stealthily seized a small can 
which he supposed to contain molasses, and drank nearly or 
quite six ounces of camphene. 

I saw the boy within an hour and a half after the accident. 
He was then in a state of profound coma, — the eyes were suf- 
fused, the pupils largely dilated, conjunctiva injected, the pulse 
130, the skin hot and dry, the mouth and fauces red and parch- 
ed, the features were somewhat corrugated and anxious, res- 
piration hurried; the abdominal muscles were very tensely 
contracted, and he lay curved, with his arms closely folded and 
pressed on his abdomen Urine that had been voided a short 
time previous to my arrival had the odor of violets. I adminis- 
tered a large quantity of olive oil. and followed it with an emetic 
of ipecac, and warm water. The matters ejected had the odor 
of turpentine, as did also the dejections from the bowels. 

The child could not be kept awake, even whde vomiting. 
There were frequent and ineffectual attempts at micturition, 
and there was constant priapism. 

I directed a tepid bath, and prescribed demulcent drinks, 
with ipecac, gr. j, every fifteen minutes. This treatment was 
continued for about eighteen hours, when the little fellow awoke 
to consciousness for the first time in nearly twenty hours. Less 
than four ounces of urine had been secreted during this coma- 
tose period ; and what was voided was tinged with blood. For 
several days the patient continued to be excessively nervous 
and irritable; but at the end of a week he had to all appearan- 
ces fully recovered. 

1853.] New Facts relating to Percussion. 1G9 

The facts in this case might be of some importance in a 
medico-legal point of view, as there are but few such cases on 
record. One very similar but less Bevere case, is mentioned 
by Ml. Taylor in his treatise on Poisons. (Vide " Taylor on 
Poisons" by Griffith, p. 426.) 

The history of my case, as well as that of Dr. Evans, quoted 
by Mr. Taylor, exhibits striking proof of the energy with which 
the oil of turpentine acts upon the nervous system of persons 
exposed to its action. — [New York Jour, of Medicine. 

New Facts relating to Percussion in Pneumonia, Emphysema, 
etc. By H. Roger. 

1. The pulmonary parenchyma, even containing less air 
than in the healthy state, gives, on percussion, a more or less 
evident tympanic sound: a portion of lung infiltrated with 
serum, or blood, or tubercular matter, and not entirely deprived 
of air, furnishes a tympanic sound more or less hollow or 
dull, in proportion to the quantity of air. In percussing the 
thorax, tympanic resonance will there be obtained in some 
cases of pneumonia, of tubercular infiltration, and of pulmonary 
Oedema and apoplexy. 

2. The natural pulmonic sound is not tympanic. The lung, 
distended more than its healthy state (vesicular emphysema), 
furnishes a sound sometimes tympanic and sometimes non- 
tympanic. Partial emphysema surrounding an engorged and 
non-aerated parenchyma (which may happen in pneumonia), 
gives rise to a resonance which is usually tympanic; while 
this rarely occurs in general emphysema, and is never present 
in interlobular emphysema. When, in emphysema, the pulmo- 
nary tissue is excessively distended by the air contained in the 
air-cells, and at the same time the thoracic walls are very tense, 
the thoracic resonance, instead of being exaggerated, as might 
a priori be expected, is diminished ; thus is explained (and not 
b) the presence of false membranes covering the lung) the 
small amount of sound which is sometimes found on percussing 
the chests of patients, who are nevertheless highly emphyse- 

3. In pneumothorax, the pectoral resonance is tympanic 
when the chest on the affected side is moderately distended, 
but scarcely ever when the tension is extreme. 

1. When the abdomen ia percussed, the varying tension of 

d»»minal wall may cause the resonance to vary : the more 

the wall is, the more obscure is ; i The same 

occurs with regard to the resonance in cases of pneumatosis, 

[Archives Gen. de Med. London Jour, of Med. 

170 Rheumatic and Non-Rheumatic Pericarditis. [March, 

Researches on the Pathology of Rheumatic and non-Rheumatic 
Pericarditis. By Dr. Ojrmerod. 

Recently before the Royal Medical and Chirurgical Society 
of London, Dr. Ormerod read a very interesting paper on these 
affections. He commenced by a reference to the researches of 
the late Dr. Taylor, who had satisfactorily shown that acute 
rheumatism was not. exclusively the cause of pericarditis, and 
who had also called attention to the importance of granular 
disease of the kidney in reference to this morbid condition. 
The author desired to limit the use of the word pericarditis to 
present inflammation of the pericardium ; and this analysis re- 
ferred exclusively to cases of this nature. The means of investi- 
gation comprehended complete records of 1410 cases observed 
under nearly similar circumstances ; that is, in the wards of 
different hospitals. Of these, 1249=88.59 percent, were not 
cases of rheumatism; 161=11.41 per cent, were admitted on 
account of rheumatism, or suffered from it w[iile under obser- 
vation. Of the whole number, 85=6 per cent, had recent 
pericarditis, observed during life, or discovered after death, and 
were thus distributed: — 

24 = 1.92 per cent, occurred among 1249 non-rheumatic cases. 
61 = 37.88 per cent. 161 rheumatic cases. 

85 =6 per cent. 1410 

The mean age of 61 subjects of rheumatic pericarditis was 
about 21 ; the mean age of 24 subjects of non-rheumatic peri- 
carditis was 42 ; the extremes being 7 and 63 years. As to the 
different causes of the pericarditis — 

Rheumatic 61 cases coincided with acute rheumatism. 

at r, Ru„ VY1 „ip .f ( 7 ensued on inflammation of lungs or pleura. 

iNon-Kneumauc oi \ g en ^ d on maligrnant disease ot tne pericardium, 

local origin, j { ensued on o]d cardiac disease. 

Non-Rheumatic of f£ coi 


coincided with ha?mo:rhage or exhaustion. 
2 coincided with scarlatina or irresipelas respectivel)'. 
2 were inexplicable. 


The date of the accession of pericarditis was determined in 
33 of the rheumatic cases. The mean of these observations 
gave the 10. 5th day of rheumatic attack as that on which the 
pericardial complication most commonly supervened. The 
question, whether a first or second attack of rheumatism was 
more likely to be accompanied by pericarditis, was beyond the 
reach of hospital statistics. Tins source of information was 
silent also on the question, whether pericarditis be more likely 
to occur in severe or in the slighter cases of rheumatic fever. 

1853.] Rheumatic and Non-Rheumatic Pericarditis. 171 

It might, however, be safely inferred, that the severity of the 
articular and pericardial affections bore no very close relation- 
ship to each other. It was certain that the most severe, even 
fatal pericarditis, might occur where there was hut faint evi- 
■ of articular affection, and this latter condition might 
exist in the most aggravated and intense form without involv- 
ing the addition of pericarditis to the other sources ofdis! 
The author then entered upon the consideration of the subject 
of non-rheumatic pericarditis of local origin ; and a question 
of importance here presented itself — What was the influence of 
preexiatent cardiac or pulmonary affections in inducing in- 
flammation of the pericardium ? The question was of equal 
importance in relation to acute rheumatism. The relation of 
pulmonary inflammation to pericarditis was thus illustrated : — 
In the 1110 cases, the basis of this inquiry, some form of pul- 
monary inflammation — that is, pneumonia, pleuritis, or pleuro- 
pneumonia — was ascertained to exist, either by auscultation or 
dissection, in "265 cases. Of these — 

117 had pneumonia, of which 10 had recent pericarditis. 

86 had pleurisy, " 6 " 

G'2 had pleuro-pneuraonia " 8 " 

965 33 = 12.4 percent. 

In the rheumatic class, pericardial inflammation commonly 
preceded, yet sometimes, though rarely, followed, pulmonary 
inflammation. The non-rheumatic class told quite a dill- 
story ; here pulmonary inflammation had apparently a distinct 
influence in inducing pericarditis, and this influence was most 
evident in cases of pleurisy ; and clinical observation bore out 
the conclusion, that the pericarditis was subsequent to, and pro- 
bably contingent on. the pulmonary inflammation. The author 
then referred to the comparative fatality of non-rheumatic 
compared with rheumatic pericarditis, and also to the desira- 
bleness of instituting an exact comparison between Bright's 
disease of the kidney and acute rheumatism, in respect to their 
tendencies to induce inflammation of the pericardium. In con- 
clusion, the author desired to ascertain how far the results ob- 
tained by his present analysis agreed with those of the published 
of Dr. Taylor, who had made the subject of non-rheumatic 
pericarditis so peculiarly his own. The deductions seemed 
identical, and one an the perusal of those elaborate 

clinical reports with aconviction that non-rheumatic pericardi- 
- more within the province of the anatomist than of the 
physician. It w,i< a disease with few or no symptoms, its 
physical - more often by a chance discovery 

than on the suggestions of the disease, and its morbid changes 

172 Total Removal of both Radius and Ulna. [March, 

small in amount and apparently inactive ; and where opportu- 
nity had occurred of watching the disease some time previous 
to death, it had been apparently without effect on the general 
symptoms, its presence or absence being determined by the ear 
alone ; and still, in these, its connection with the fatal termina- 
tion had appeared to be that of a coincidence rather than of a 

Dr. Copland felt obliged to the author for the very practical 
and literary way in which he had brought his paper before the 
Fellows of the Society. The association of disease, as exem- 
plified in Dr. Ormer</d's communication, showed us that, in 
practice, we must not look at cases of disease as always simple, 
but frequently as complicated as those under discussion. All 
these were connected with the morbid condition of the blood, 
and to this we must look as the cause of the articular rheuma- 
tism, the pericarditis, pleuritis, &c. All these were evidences 
of the blood being in an abnormal condition, from whatever 
cause it originated. Several organs became affected, and when 
an -important disease existed, it masked the minor one. We 
saw the same train of phenomena in Bright's disease, in which 
inflammation of the serous membranes was liable to occur from 
the non-elimination of morbid matter from the blood, and its 
consequent circulation through the system. These combina- 
tions of disease should be viewed in our routine of practice as 
the result of the morbid action in the system. — [Dublin Medi- 
cal Press. 

Case of Total Removal of both Radius and Ulna. By Dr. 
Compton. (Reported by A. Thibaut.) 

Thomas Harris, get. 15, admitted during the month of Febru- 
ary, for a lacerated wound of scalp and ear; fracture of inferior 
maxillary and humerus: compound comminuted fracture of 
radius and ulna. 

These injuries were received on board the English ship 
Manchester. It appears that the boy was sleeping on the an- 
chor chain ; and that the anchor was suddenly let down ; in its 
progress, the chain caught the arm and produced the injuries 
above mentioned. When the boy was admitted, the wounds 
had been dressed for several days, and from want of proper 
attendance and care, were in a very filthy condition. The 
arm, especially, was in a sloughing state, and both radius and 
ulna were actually shattered to pieces, and protruding several 
inches out of the mass of muscles. 

By the 18th of April, the boy being well of all the other inju- 

1853.] Dislocation of the Eye. 173 

ries, Dr. Compton determined to remove both the radius and 
ulna, lie made a straight incision the whole length of the 
inner side of the radius, and a counter-opening opposite the 
olecranon process. Having dissected out both bon< b carefully, 
and disarticulated them at the elbow, he removed them entire 
with the exception of a portion of the lower end of the radius. 
A great portion of the periosteum was detached from the hones, 
and left in the wound. The usual treatment for such opera- 
tions was then followed and the patient improved rapidly, and 
the wound had nearly healed, when several abscesses formed on 
the fore-arm. These abscesses were, according to Dr. C.'s 
opinion, produced by pieces of bones which had been left in the 
arm. His opinion was well grounded, for several spicula of 
bone came out of the wound, and the arm immediately assumed 
a healthy condition, and is now well. The arm is about two 
or three inches shorter than the other and is perfectly firm. It 
remains at a right angle to the humerus, and can be flexed and 
extended so that the hand moves through eight or ten degrees 
ofanarcof a circle. He has entire use of the hand — he can 
both open and shut it, and he grasps objects quite firmly. The 
pulse in that arm can be felt as well as in the other. — [Neiu Or- 
leans Med. Register. 

Case of Dislocation of the Eye. By William Jameson, M.D., 
F.R.C.S., Surgeon to Mercer's Hospital. (From the Pro- 
ceedings of the Surgical Society of Ireland.) 

Dr. Jameson said he would detain the Society but for a very 
short time in detailing a case of dislocation of the eye. which 
had lately come under his observation in Mercer's Hospital : — 
Peter Nowlan, setat. 30, a powerfully able and muscular man, 
a corn porter, was admitted into Mercer's Hospital on the 3d 
of November, at half-past 12 at night. His wife informed me 
that he came home that evening at ten o'clock in a most intox- 
icated condition, and while staggering about his room, struck 
his right eye against a small iron hook or nail that was in a 
dresser, which entered at the outer angle of the upper evelid of 
that side, and when she went to his assistance discovered his 
eye protruded from its socket. She was most anxious to re- 
move him at once to hospital, but could not succeed in prevail- 
ing on him to go until half-past twelve at night, when in a few 
minutes after this I saw him. 

He was very boisterous and unruly, had a large cheek apron 
held close up to his eye. which he kepi constantly rubbing 
pressing against it. On its being removed, he presented a 
most peculiar, and I might add, frightful appearance. There 

174 Dislocation of the Eye. [March, 

was the right eye protruded out of the orbit, firmly fixed and 
immoveable, staring, elastic to the touch, and devoid of all 
power of vision. The cornea was dry, cloudy, and rather 
opaque, pupil moderately contracted, and uninfluenced by the 
light of a candle. There was no extravasation of blood, nor 
was there any vascularity of the conjunctiva, although its re- 
flection from the upper lid on the globe of the eye was partially 
torn through. The inferior margin of the upper lid was not 
visible, as it was placed behind the globe and spasmodically 

With difficulty I could get him restrained, as he was such a 
powerful man, but having accomplished it, I then, with two 
fingers of my left hand, elevated the upper lid, at the same 
time, with the finger and thumb of my right, pressed the ball 
of the eye, and immediately it w r as drawn back with a distinct 
snap, and the lids closed over its anterior surface. I now, for 
the first time, observed the small wound before alluded to at 
the outer angle of the upper lid, but could not ascertain or form 
any conjecture at the time what amount of injury he might 
otherwise have sustained. I therefore had him conveyed to 
bed, and ordered cold to be assiduously applied to the part for 
the remainder of the night. 

4th. The following morning, at visiting hour, we found him 
sober, but recollected little of what had occurred. His eyelids 
were a little swollen ; there was some slight vascularity of the 
conjunctiva; the cornea was clear, shining, and moist, and the 
tears ran down the cheek; he could distinguish the daylight; 
complained of pain in the head, and a deep pain in the globe 
of the eye, with full pulse. He was ordered to have !xvi. of 
blood taken from his arm, bowels to be freely opened, and the 
cold to be continued to the part. 

5th. Lids less tumid; pain and vascularity of conjunctiva 
almost gone; complains of the sensation as if gravel were be- 
tween the lids; vision improved, but sees objects imperfectly, 
as through a thick haze. Ordered the tart. ant. mist., low diet, 
and the cold application to be continued. 

6th. All pain gone ; conjunctival vascularity less ; sensation 
as if gravel were beneath the lids gone ; vision nearly restored; 
has complete power over all the motions of the eye. Contin- 
ue all. 

7th. Convalescent ; no suffusion ; no pain ; vision complete. 

9th. Discharged cured. 

The foregoing case I consider to be one of great interest, 
when we reflect on the novelty and nature of the accident, 
and the mode of its being inflicted. In the first instance, the 
great escape the orbital plate of the frontal bone had of being 

Prevention of Puerpei al Mania. 175 

pierced, and consequent injur)' to the anterior lobe of the brain. 
Again, the length of time the cornea was lefl uncovered by the 
palpebrse, being two hours and a half, and all that time coarsely 

rubbed by the apron. The great state of tension the optic 
nerve must have been kept in without permanenl losa of\ ision. 

The escape the muscular attachments had of being torn from 

their origins, which evidently must have been the case from 
the subsequent perfect control retained over all the motions 
of the eye, as soon as the very slight amount of inflammation 

produced by the accident was removed. The powerful con- 
traction of the orbicularis muscle behind the globe, with the 
complete restoration of vision. And finally, the trifling amount 
of constitutional disturbance and local inflammation that fol- 
lowed what appeared to be at first sight so very grave an 
accident to so very delicate an organ. These, I say, are points 
which add considerably to the interest of the case. 

Dr. Jacob said the Society were greatly indebted to Dr. 
Jameson for the very interesting case he had just brought un- 
der their notice. As far as he could recollect, one of exactly 
the same kind was scarcely to be found on record. He thought 
it was a case which ought not to be dismissed from their con- 
sideration, without some suggestion to account for the occur- 
rence of such an accident. He would solve the matter in this 
manner: Some persons were born with very large eyes and 
shallow orbits, and often, while examining the eyes of such 
persons, he found that by pressing the lids above and below, 
he could with ease get a view of the back of the eye. It was 
not that he merely saw one-half of the eye, but by a little ma- 
nipulation of the eyelids, in persons with a shallow orbit and a 
large eyeball, he could obtain a view of the posterior part of 
the ball. Now, if by means of violence, the lids were tucked 
in above and below, "they would grip the back of the eye and 
produce a downright protrusion of the organ from the orbit. 
He could not conceive any other way in which the accident 
could happen, because, as they might recollect, neither the 
muscles nor the optic nerve were torn in the case described 
by Dr. Jameson. 

Dr. Jameson — The circumstance of the eye being drawn 
back with a distinct snap, shows that the muscles were at least 
on the stretch. 

Dr. Jacob— Yes, that is quite evident.— [Dublin Med Pr IS. 

On th r niion ofPuer / Prof. Sim 

Recently, before the Edinburgh Obstetrical Society, Dr. 
Simpson gave an account of the use of chloroform in patients 

176 Transformation of the Encysted Entozoa. [March, 

predisposed to puerperal mania. He stated the particulars of 
three cases in which chloroform was used in patients, who in 
former confinements had been the subjects of puerperal mania. 
In none of these cases did the disease return. One of them had 
borne several children previously ; and after each labor, had 
ben attacked with puerperal mania, but had entirely escaped 
from any recurrence whatever of the disease after the last labor, 
in which he had employed chloroform. — [Monthly Journal of 
Medical Sciences. 

On the Transformation of the Encysted Entozoa into Tape- 
Worms. By J no C. D alton, Jr., M. D. 

The following report of some experiments by Prof. C. Th. 
von Siebold, will be found of considerable importance, not only 
from their general zoological interest, but more particularly 
from their bearing on the question of spontaneous generation. 
Notwithstanding that the idea of spontaneous or equivocal gen- 
eration is repudiated by the great majority of physiologists at 
the present day, it seems to be still entertained in some quar- 
ters, even by men of considerable scientific attainments. The 
defences of this theory, however, have one after another given 
way before the advance of zoological science. It was demon- 
strated long ago by Redi and Valisnieri, that the worms, which 
appear in putrefying flesh, were not produced, as previously sup- 
posed, from the decomposing animal matter itself, but were the 
larvae of winged insects, which had been led, by a curious in- 
stinct, to deposit their eggs in such places as would afford the 
necessary food to the young and imperfect progeny during the 
earliest stages of its existence. The Italian observers thus ex- 
plained, in the most natural manner, what seemed to be a very 
puzzling circumstance, viz., that these worms, which always 
showed themselves in great numbers in decomposing animal 
substances, were not to be found in any other situations. The 
species seemed to be confined to putrefying substances ; and as 
they often appeared under circumstances which precluded the 
idea of their having been transferred from other collections of 
decomposing matter, it was not easy to understand how they 
could have originated by the ordinary mode of generation. 
Redi and Valisnieri, however, demonstrated that they were the 
progeny of perfect insects ; and that the species was not in 
reality confined to decomposing substances, but existed else- 
where, though in a different form. 

The existence of the infusorial animalcula, again, seemed for 
a time explicable only on the supposition that they were pro- 
duced spontaneously in the animal or vegetable infusions which 

1853.] Transformation of the Encysted Entozoa. Ill 

Ihey inhabited. But this supposition lias been sel entirely at 
rest since the experiments of Schultze,al Berlin, in 1837, proved 
that though the production of infusoria was almost invariable 

when the infusion was kept -at. the proper temperature and ex- 
posed to the access of atmospheric air, — yet that the animal- 
cules were not generated if sufficient care were taken to pre- 
clude all possibility of living germs being introduced into the 
infusion from without. We take it, therefore, Dot even the 
most determined advocate of the theory of equivocal genera- 
tion will place much reliance on the celebrated experiment of 
the production of the acarus Crossii from the continued action 
ofgalvano electricity on a crystalizable saline solution ; — par- 
ticularly as the acari so produced possessed generative organs, 
and the females, soon after their appearance, provided for a 
continuance of the species by an abundant production of ova. 
The chances of the accidental introduction of living germs 
into the machine during the course of so long-continued an ex- 
periment are too great to allow any one to remain satisfied 
without a personal inspection of the apparatus. 

The only remaining defence of the spontaneous generation 
theory, is the existence of entozoa; and it is behind this last, 
and apparently most impregnable barrier, that its partizans 
have finally entrenched themselves. r l ne entozoa, like the in- 
fusoria, are confined to certain situations. They are never de- 
tected out of the living body. Particular species of animals 
are even infested by particular species of parasites, and by no 
others. The Taenia solium inhabits the intestines of the hu- 
man subject, the T. serrata those of the dog, the T. crassicollis 
those of the cat. In the same individual, even, different organs 
are occupied by different entozoa. We must look tor the Tri- 
chocephalus dispar in the ccccum, for the Strongylus gigas in 
the kidney, and for the Distoma hepaticum in the liver. " These 
facts," it has been said,* "seem to show that some extremely 
local concurrence of circumstances is essential to the produc- 
tion of the several entozoa." But it is very easy I i see that 
these strictly local conditions may be not at all necessary for 
the production, but only for the development of the entozoa. It 
is certainly no more surprising that one species of Ascaris 
should inhabit the large, and another the small intestine, than 
that the Lobelia inflata should grow only in dry pastures and 
the Lobelia cardinal is by the margin of meadow-brooks. 
The Lichens flourish on the exposed surfaces of rocks and 
stone walls : while the Fungi vegetate in darkness and moisture 
on the decaying trunks of dead trees. Yet no one imagines' 

Stilles Pathology, Philadelphia, 1848, p. 473. 

178 Transformation of the Encysted Entozoa. [March, 

these vegetables to be spontaneously generated from the soil 
which they inhabit. The fact is simply this : that if the ani- 
mal or vegetable germ be deposited in a locality which affords 
the conditions necessary for its development, it becomes de- 
veloped ; otherwise not. The grains of wheat which had 
remained for centuries, WTapped up in the cerements of Egypt- 
ian mummies germinated freely when exposed, in an appropriate 
soil, to the influences of light, air, warmth and moisture. The 
circumstance, therefore, that particular parasites are confined 
to particular localities presents no greater difficulty as to their 
mode of reproduction, than the same fact regarding other ani- 
mal and vegetable organisms. 

Every articulation of the Taenia solium contains, when in a 
state of maturity, many thousands of ova ; all of which are 
necessarily expelled from the body when the articulation drops 
off. Now though the chances are enormous against any par- 
ticular one of these ova being accidentally transported into the 
intestinal canal of another individual, it is easy to see that there 
are many causes in operation by which some of them might be 
so transported. By far the greater number undoubtedly perish, 
from not meeting with the conditions necessary to their devel- 
opment. One in a thousand, or, perhaps, one in a million, is 
accidentally introduced into the body of another individual, 
and consequently becomes developed into a perfect animal. 

The greatest difficulty, however, was presented by the 
encysted entozoa, which are not only confined to particular 
organs, like other parasites, but which are also destitute of any 
generative apparatus. Now, a species which is destitute of 
generative organs evidently cannot reproduce itself; and the 
encysted entozoa have therefore been regarded as presenting 
at least one undoubted instance of equivocal generation, i. e., a 
progeny without parents. The fact that no similar animals 
were found external to the body might have been got over ; 
but that those existing as parasites in the parenchyma of living 
organs were themselves destitute of any generative apparatus, 
seemed to exclude the idea that they had been produced by the 
ordinary modes of propagation. 

It is strange that those who advocated so strenuously the 
doctrine of equivocal generation could not see that this cir- 
circumstance might be explained in the same way with the pro- 
duction of maggots in putrefying meat ; a point which had been 
settled so long ago by Redi and Valisnieri. These maggots 
differ in structure from their parents because they are as yet 
incomplete. They may be considered, to some extent, as still 
in a fetal condition. For the same reason the generative or- 
gans are not yet developed. The larva is incapable of repro- 


1853.] Transformation of the Encysted Entozoa. 179 

ducing itself as a larva. But after it has passed through the 
natural transformations, and its organization is completed, a 
sexual apparatus appears, and the species, though not every 
individual belonging to it, is found to be perfect. Now. by 
watching the growth of any one individual, from the egg to the 
state of a complete insect, we get a history of its transforma- 
tions, and comprehend that the animal may be destitute of sex- 
ual organs at one period of its existence, and provided with 
them at .another. .But if the conditions necessary to the later 
stages of development are wanting, the larva will not he trans- 
formed into an insect, but will remain a larva; and, of course, 
so long as these conditions are wanting, so long will the sexual 
organs remain absent. And this is precisely the case with the 
encysted entozoa. They bear very much the same relation 
to the Taenia as the undeveloped larva to the perfect insect. It 
is, perhaps, unnecessary to remind our readers that the Taenia 
is not now considered as a single animal, but as a colony of 
animals; every articulation being a distinct individual. These 
articulations are multiplied by a process of budding, which 
takes place just behind the "head," or most anterior individual 
of the colony. As new ones appear, those which were previ- 
ously produced are pushed farther and farther from the "head ;" 
so that the oldest articulations are those situated at the posteri- 
or extremity of the chain. The young and imperfect individu- 
als compose the "neck" of the Taenia. They are, as vet, 
without sexual organs ; but as they increase in size, and are 
gradually removed farther from the head, they become provided 
with a sexual apparatus, each articulation containing both male 
and female organs; so that the posterior portion of the chain 
is composed of completely developed hermaphrodite individu- 
als. As these individuals arrive successively at maturity, they 
become detached from the chain, and pass out of the intestine 
with the faeces, after which the ova are probably set free by 
the death and decomposition of the parts which enclose them. 
A portion, then, of every '-tape-worm" is destitute of repro- 
ductive organs, and yet it has itself undoubtedly been produced 
from ova, and will hereafter, if circumstances are favorable, 
produce ova in its turn. 

Now the following experiments, by Prof. Von Siebold. dem- 
onstrate the very important point that those parasites which 
have been regarded as incapable of reproduction ccies, 

are really incapable of it only as individuals, because they have 
been prevented from arriving at their mature condition: and 
that the sexless encysted entozoa arc in reality only undevel- 
oped or diseased Taenia. We have ascertained by personal 
inquiry, what might have been anticipated from the previous 

180 Transformation of the Encysted Entozoa. [March, 

reputation of the observer, that both the experiments, and the 
results derived from them, are regarded by scientific men in 
Germany, as entitled to complete confidence. The following 
account of the experiments is translated from a report, in the 
" Silesian Times,'' of the Transactions of the " Silesian Associ- 
ation for National Instruction, Scientific Department, Session 
of July 7th, 1852:" 


Professor Von Siebold made a report on the experiments 
which were undertaken some months previously, in the Physi- 
ological Institute, under his direction, for the purpose of show- 
ing the possibility of a transformation of the cystic parasites 
into tape-worms. He had already, in the year 1844, in the 
second volume of the Encyclopoedia of Physiology, expressed 
the opinion that the parasitic cysticercus (C. fasciolaris,) found 
in the liver of rats and mice, was nothing else than an abnor- 
mal, dropsical tape-worm ; and that it was, in reality, identical 
with the tape-worm of the cat (Taenia crassicollis.) He main- 
tained further that the Cysticercus fasciolaris, like all cystic 
worms, was invariably destitute of sexual organs, and could 
not multiply its species by generation, unless it were transferred 
to a favorable locality, where it might lose its dropsical condi- 
tion and develope its sexual organs. These changes actually 
take place when a rat or a mouse, with a Cysticercus fasciolaris 
in its liver, is devoured by a cat. The parenchyma of the 
liver, according to Siebold, is digested in the stomach of the 
cat : but not so the entozoon. The parasitic animal loses only 
its dropsical appendage, and passes, with the digested food, 
from the stomach of the cat into the small intestine. It then 
finds itself in a favorable locality, and becomes developed into 
a perfect tape-worm, with articulations and sexual organs 
(Taenia crassicollis.) This idea had been first suggested to 
Prof Siebold by the perfect resemblance between the cephalic 
extremity of the Cysticercus fasciolaris and that of the Taenia 
crassicollis; and by the fact that there are often found, in the 
intestine of the cat, several specimens of the T. crassicollis, in 
different stages of development. His opinion was adopted by 
many naturalists, but its correctness had also been called in 
question by others. Some years ago Dr. Kuchenmeister, of 
Zittau, had made use of the Cysticercus pisiformis, a species 
of encysted parasite very common in the peritoneum of hares 
and rabbits, for a series of experiments in which he caused these 
parasites to be swallowed by dogs and cats ; in the expectation 
that they would become developed into tape-worms in the in- 
testine of these animals. The trial succeeded perfectly with 

1853.] Transformation of the Encysted Entozoa. 181 

dogs ; and the same thing that Prof. Siebold had previously 
inferred from a comparison of the Cysticercus fasciolaris of 
rats and mice with the Taenia crassicollis of the cat, would 
seem to have been definitely established by these experiments 
of Kuchenmeister. But Kuchenmeister's experiments, and the 
conclusions he drew from them, did not prove satisfactory either 
to naturalists or medical men. He had committed the error of 
publishing his investigations before they could properly be con- 
sidered as terminated. He was consequently obliged, in the 
various communications which he published on the subject, one 
after another, in the medical journals of northern and southern 
Germany, to correct many of his former statements, and even 
to retract some of them; and he entangled himself, finally, in 
so many contradictions that it is to be feared the doctrine of a 
close relation between cysticerci and tape-worms was rather 
retarded than advanced by his activity ; particularly as he him- 
self several times acknowledged that he was not sufficiently 
familiar with the study of intestinal worms to distinguish them 
with certainty. Such a confession certainly was not calcula- 
ted to increase the confidence of naturalists in his experiments. 
He also exhibited his incapacity to distinguish the entozoa by 
giving, in succession, several different names to the newly pro- 
duced tape-worm, which he described at first as the " Taenia 
crassiceps" of the fox, afterwards as the " Taenia serrata" of 
the dog. and finally as an entirely new species, under the name 
of the "Taenia pisiformis." Prof. Siebold then determined to 
undertake himself similar experiments. They were tried prin- 
cipally on young dogs, not only with the Cysticercus pisiformis, 
but also with the C. cellulosa, C. tenuicollis, Casnurus cerebra- 
lis, and Echinococcus veterinorum. 

The following results were obtained from the experiments 
with the Cysticercus pisiformis. These entozoa, which are 
usually about the size of a pea, were given to young dogs, mix- 
ed with milk, still enclosed in their peritoneal cysts, and in 
quantities varying from thirty to sixty. The dogs were after- 
wards killed with chloroform, at various intervals of time, and 
the contents of the stomach and intestine being carefully exam- 
ined, the entozoa were rapidly discovered in various stages of 
development. Two hours after being swallowed, they were 
almost all found still in the cavity of the stomach. The 
however, which had enclosed them, were gradually digested 
and destroyed, and at the same time, the greater number were 
not only freed from their envelope, but had also lost the vesi- 
cular portion of their posterior extremity. This vesicle was 
either entirely digested or else hung in shreds attached to the 
end of the body. All the entozoa, which were found in the 

N. 9. — vol. ix. xo. in. 13 

182 Transformation of the Encysted Entozoa. [March, 

stomach, whether they had lost the vesicular appendage or not, 
invariably had the head and neck drawn back into the body. 

When the dogs were killed after an interval of three hours, 
no entozoa were found remaining in the stomach. They had 
all passed, together with the digested food, into the small intes- 
tine. Their cysts and vesicular appendages had all been 
destroyed by the digestive processes in the stomach ; but the 
head and neck were again, without exception, protruded, and 
the body, which had been before contracted, was stretched out 
longitudinally. In all of them were to be seen marks of injury 
at the posterior extremity of the body, where the vesicular ap- 
pendage had been attached. When the dogs were suffered to 
live several days after the commencement of the experiment, . 
the entozoa were found to have considerably increased in size. 
The largest had attained the length of three inches, the small- 
est that of one inch. The body, which had previously shown 
only transverse wrinkles, now exhibited very plainly articula- 
tions in its central portion. The posterior portion was still 
wrinkled transversely, and the lacerated spot at its extremity 
had assumed the appearance of a cicatrix. 

After twenty or twenty-five days, the entozoa were already 
several inches long, and perfectly articulated quite to their pos- 
terior extremity, where the cicatrix was still evident ; and on 
the posterior articulations were to be discovered traces of a 
sexual apparatus. 

After eight weeks the cysticerci in the intestine of one of 
the dogs had attained a length of many inches. The largest 
were thirty-six to thirty-nine inches in length, and their poste- 
rior articulations were provided with a perfectly developed 
sexual apparatus, and contained many mature ova. Several 
of those a yard long had already thrown off their posterior 
articulations, with their mature sexual products. Von Siebold 
was now able to recognize, in this tape-worm, developed out of 
the Cysticercus pisiformis, the Taenia serrata of the dog. The 
cephalic extremity, the form of the articulations, the structure of 
the generative organs, and particularly the mature ova of this 
tape-worm, corresponded, in the most perfect manner, with the 
same parts in the Taenia serrata. There was no longer any doubt 
that the Cysticercus pisiformis of the hare and rabbit bore the 
same relation to the Taenia serrata of the dog, as the Cysticercus 
fasciolaris of rats and mice to the Taenia crassicollis of the cat. 
Furthermore, the T. serrata is rarely met with in the intestines 
of parlor and house dogs, but is, on the contrary, very abundant 
in hunting dogs ; no doubt because the latter are often allowed 
to devour the entrails of hares killed in the chase, swallow at 
the same time the Cysticercus, and so become infested with the 

1853.] Transformation of the Encysted Entozoa. 183 

Taenia ; a circumstance which would naturally be less frequent 
with parlor and house i\"^<. 

Although Siebold's experiments with the other species of 
encysted entozoa, mentioned above, were not entirely finished, 
he had yet carried them so far with the " Ceenurus cerehralis " 
as to convince himself that this worm, also, which is so much 
dreaded by sheep-breeders, becomes developed, in the aliment- 
ary canal of the dog, into a tape- worm. The tape-worm pro- 
duced from this parasite had not yet, in Siebold's experiments, 
become developed to the stage of sexual maturity ; so that he 
was si ill unable to determine with certainty its species. He 
hoped, however, by means of continued trial, to produce from 
the Coenurus cerehralis perfectly mature Taenia ; so that he 
might be able, after distinguishing their species, to determine 
what animal it is in whose intestine the sexless Ccenurus cere- 
hralis becomes developed into a tape-wotm with mature sexual 
apparatus. He will then, probably, have it in his power to give 
agriculturalists some hints how to prevent the development of 
this parasite in the brain of the sheep. For he is convinced 
that the encysted entozoa do not originate by spontaneous 
eration, but are produced from the microscopic ova of the tape- 
worms of certain carnivorous animals, which are introduced 
by accident into the bodies of rodentia and ruminantia. Here 
they are not developed into tape-worms ; but degenerate into 
encysted worms, which exert a more or less injurious influence 
on the life of the animal, according to the importance of the 
organ in which they have taken up their residence at the ex- 
pense of which they live. 

The experiments which have been commenced with the 
Echinococus veterinorum have already shown that this parasite 
is also to be considered as a tape-worm. The progeny of this 
destructive entozoon are produced, as is well known, in great 
numbers, by a process of budding from its inner surface. 
These were given in spoonfuls to young dogs, and in a few 
days afterward thousands of exceedingly small tape-worms 
were discovered, fastened by their four suckers to the mucous 
membrane of the small intestine. The bodies of these tape- 
worms consisted of only three divisions, viz., a head and neck 
for the first division, then a small articulation, and finally a 
longer one at the extremity. In both of these articula!inns"the 
sexual organs had already begun to show themselves. They 
were not yet, however, so far developed that the worms could 
be considered as in a state of maturity, or their species accu- 
rately determined. It is Prof. Siebold's intention to continue 
these tents : and he hopes, at some future time, to com- 

municate their results to the Association.— [Buffalo Med. Jour. 

184 Quina in Typhus Fever. [March, 

On the Treatment of Typhus Fever by Sulphate of Quina. By 
Dr. F. M'Evers, Physician to the Cork Fever Hospital, &c. 

[In one of our preceding volumes (Part XXV., p. 17), the 
reader will find an interesting paper on the treatment of typhus 
by quinine, from the pen of Dr. Dundas, of Liverpool. There 
is great merit due to this gentleman in introducing this medi- 
cine as a remedy for typhus by seeking to identify the poison 
of this fever with the remittents and intermittents of the trop- 
ics. Dr. Skete, so far back as 1786, broached a similar opinion. 
This author says,] 

" If the remittents of warm climates are but the continued 
fevers of this country, in a more violent degree, and if the 
effects of the bark are admitted in such remittents, does it not 
necessarily follow that bark would be endowed with similar 
powers, even in the fevers which every day occur to our no- 
tice, I mean those of the typhus kind, which are frequent in all 
large towns, especially London and Edinburgh." 

[As we have before stated in the preceding volumes, Dr. 
Dundas' plan is to administer the quina in ten grain doses, until 
dizziness of the head, or tinnitus aurium, is produced ; or until 
a general amelioration of the symptoms takes place. When 
tinnitus aurium or dizziness of the head are very urgent Dr. D. 
resorts to an emetic ; and he says, if emetics are had recourse 
to at an earlv period, the quina is likely to be more success- 

This treatment is resorted to in all stages of the disease, and 
frequently in the advanced periods, under circumstances which 
would be considered by the experienced physician as indicative 
of the worst form of typhus fever; and this mode of adminis- 
tering quina is almost invariably attended with the happiest 

Immediately after having become acquainted with Dr. Dun- 
das' views on this subject, several persons labouring under bad 
maculated typhus were admitted into our hospital, which gave 
me opportunities of testing the value of his opinions ; and I 
must confess that I pursued the inquiry with much doubt, as I 
looked on some of the cures related by him to be of too mar- 
vellous a kind to justify my adoption of this treatment without 
further confirmation of its value : however, I have now tested 
the remedy in nine cases, and, with the exception of one, it has 
been signally successful. The first of these cases was the fol- 
lowing, the notes of which I take from the daily reports of the 

Pat Ryan, aged 28, a labourer, was admitted into the hospi- 
tal on the 1st January, 1852, from Hop Island. His urgent 

1853.] Quina in Typhus Fever. 185 

symptom is heacache ; pulse 100; tongue foul ; skin hot; had 
taken purgatives at home, and was treated since admission in 
the usual way with salines, ablutions, &c, until the thirteenth 
day of his illness, when the usual symptoms of bad typhus be- 
came apparent. On the previous day his skin was mottled, and 
now the entire surface has assumed a dusky hue. Pulse 112, 
feeble ; tongue parched, with sordes on the teeth and lips ; 
no sleep ; bowels free ; some general fulness of the abdomen, 
with epigastric tenderness ; kidneys acting ; headache increas- 
ed, and raves a good deal. He was ordered to take ten grains 
of sulphate of quina every second hour, and to have broth and 
four ounces of port wine. 

The changed condition of this patient at my next visit was 
most remarkable ; the pulse was considerably reduced ; the 
tongue was moist and cleaning, in fact it had lost the dark colour 
and parched appearance it presented the day before. The man 
slept ; there was less abdominal fulness and tenderness ; the 
kidneys acted well, and the bowels were free. He took sixty 
grains of quina, without its having produced dizziness or tinni- 
tus aurium. The medicine was given in the form of mixture 
with a little sulphuric acid, — the two or three last doses sick- 
ening him a little. I then ordered it in the same dose in the 
form of pills, repeating it every three hours, which he bore 
without sickness. On this day he took forty grains, and on the 
following day he was convalescent. It is remarkable that the 
father of this patient, who was admitted a few days before, 
passed through the same type of fever, treated in the ordinary 
way, and died on the fifteenth or sixteenth day of his illness. 

The second case was that of a young man, aged 19, admitted 
on the 14th Jan., for some days under my care, whose urgent 
symptom was headache, with great prostration of strength. 
On the eighth day his breathing became very much hurried, 
unattended, how T ever, with cough, nor did the stethoscope elicit 
any abnormal sound : the man being remarkably pallid, except 
during two short exacerbations which occurred in the twenty- 
four hours. I ordered him aromatic spirit of ammonia mixture, 
with a small quantity of wine, and a sinapism to his chest. The 
following [Doming, on examining the chest, I discovered a pur- 
ple patch occupying the part to which the mustard had been 
applied. His respiration was improved, but he complained of 
intense headache. Pulse 10S. and feeble ; no sleep. The pur- 
ple patch induced me to make a careful examination of his 
body, and on turning him in the bed I observed the lower por- 
tion i»i the hick ami the nates covered with purple maculae. 
The case I looked on then as well adapted for the administra- 
tion of quina, and, accordingly, 1 ordered ten grains every two 

186 Quina in Typhus Fever. [March, 

hours, together with broth, and two ounces of port wine. The 
third dose produced violent headache, with tinnitus aurium, 
when the medicine was discontinued. At my next visit, on 
the following morning, all his symptoms were improved ; the 
tinnitus aurium left him in a short time after the medicine was 
laid aside, and the headache was greatly mitigated ; he slept, 
and expressed himself much better. I placed him again on the 
quina, when the third dose produced the same results as yes- 
terday, but there was so great an amelioration of all his symp- 
toms that I considered him proceeding to convalescence, and 
gave him only two grains of quina three times a day, after 
which he rapidly recovered. 

The next two cases were females, both of whom presented 
unfavourable symptoms, and in whom the remedy was equally 

The fifth case was one of great interest, exhibiting other 
symptoms of an unfavourable nature, in addition to those enu- 
merated in the preceding. 

John Eames, aged 55, a smith, was admitted on the 23d of 
January, with bad typhus, having been discharged from hospi- 
tal on the 3rd inst., cured of ordinary fever with bronchial 
complication. On the ninth day of his second attack he be- 
came mottled and talked incoherently ; on the tenth day he 
was not improved ; he had no sleep; the tongue was parched 
and dark, and protruded with difficulty; stools involuntary ; 
pulse 120, and feeble. He was ordered to take ten grains of 
sulphate of quina every second hour, and to have broth and 
two ounces of port wine. 

Half-past 9, p.m. The quina w r as commenced at 1 o'clock ; 
he has taken fifty grains, and appears improved in every re- 
spect ; he is more collected, and speaks with less difficulty; he 
has had two large voluntary evacuations from the bowels ; the 
medicine was directed to be continued. 

On the 11th day, I found that he had taken sixty grains since 
my last visit, and although he did not sleep much, and had some 
singultus in the night, he was much improved in other respects. 
The pulse had come down to 100 ; the tongue was still parch- 
ed and brown, but he was perfectly conscious ; he was very 
deaf and the maculae were improved in colour. On this day 
he took only four doses of quina, it having been omitted on 
account of the " buzzing," as he expressed it, which the remedy 

12th day. Pulse 96 ; tongue moist and cleaning ; bowels 
open, and he passes water freely ; to take five grains of sulphate 
of quina every fourth hour. 

13th day. Pulse 84 ; tongue clean ; skin cleaning and scaly; 

1853.] Quina in Typhus Fever. 187 

I will not occupy time with the details of all the cases in 
which I have tried this remedy, but will content myself with 
the recital of one more case, which occurred within the last 
few days, and which I consider in every way worthy of obser- 

Mary Delany, aged 22, admitted from Ballincollig on the 10th 
March ; nine days ill : headache ; petechia? ; pulse 120, and very 
feeble; tongue parched; got the usual aperient of the hospital. 

10th day. One stool ; pulse 130, feeble ; tongue parched and 
split ; great thirst ; respiration hurried ; had no sleep ; she is 
often flushed, and in the intervals deadly pale ; countenance 
anxious, with the appearance of suffering; great fulness of ab- 
domen, with tenderness on pressure, especially at the epigastri- 
um : macula? of a dark brown. She was ordered ten grains 
of sulphate of quina every second hour, and to have broth and 
two ounces of red wine. 

11th day. Bowels not open ; tongue moist and cleaning; 
pulse 100 ; kidneys acting. 

12th day. At eight p. m. last evening this girl became very 
stupid ; '• did not know what to do with her head," as she ex- 
pressed herself: she also became deaf, and had tinnitus aurium ; 
this state continued until midnight, with occasional sleep, when 
she became "lighter," and afterwards slept well ; the kidneys 
have acted, but there is no discharge from the bowels ; she now 
presents a totally different appearance from that of yesterday ; 
she is free from headache ; her respiration is natural, the ten- 
sion and fulness of belly have disappeared; but there is still 
some slight epigastric tenderness ; some of the maculae have 
disappeared, and the remainder are of a lighter colour. The 
sulphate of quina to be continued every fourth hour. 

13th day. No stool; tongue clean and moist; pulse 84; 
belly natural, slight epigastric tenderness. The quina to be 
omitted ; broth and wine to be continued : to have a domestic 

14th day. Convalescent. 

Since the first introduction into Europe of the Jesuits' bark 
in 1649, the most celebrated writers extolled its efficacy in the 
treatment of various diseases, but especially in fevers; owing, 
however, to some cause or other, it fell into disuse ; and it is 
probable that this was occasioned by the many failures which 
attended its administration ; failures which I now feel assured 
owing principally to two causes : — first, the bark not 
having been given in sufficiently large doses; and secondlv, 
the bark not having been always of the L r <'nuine kind. Its use 
was revived by the celebrated Sydenham, and after the time 
of that eminent man, its excellent qualities were fully establish- 

188 Nocturnal Incontinence of Urine. [March, 

ed by Hoffman, De Haen, Pringle, Cleghorn, and other practi- 
tioners of eminence. And it is worthy of remark that those 
who were most enthusiastic in praise of this remedy gave it in 
very large doses. Dr. Clark, a celebrated physician who wrote 
on fever in the year 1770, was in the habit of prescribing bark 
in two drachm doses every two hours, and at the same time of 
exhibiting it by the rectum in the form of enema; he relates 
that on one occasion in mixing a dose of bark for a patient, he 
discovered that the apothecary had by mistake put half an 
ounce of bark into each paper instead of two drachms, which 
he had ordered ; the patient had been taking this large dose 
for a considerable time, and got cured of a bad typhus in con- 
sequence. Now, when it is estimated that two pounds of good 
bark will yield about two hundred grains of sulphate of quina, 
it must be admitted that Dr. Clark's treatment of typhus was 
not far short of the heroic method of the present day introduced 
by Dr. Dundas. It is unnecessary to advert to the fact that 
Dr. Clark's patients were taking a different preparation, possess- 
ing, how T ever, the same active base. 

One great objection to its general use in this country, which 
may be advanced, is the high price of the salt ; but should the 
remedy be found as efficacious in the practice of others as by 
Dr. Dundas and myself, I feel assured that its use, when appli- 
cable, would eventually constitute the true economy, of our 
fever hospitals. — [Dublin Quar. Journ. Braithwaite. 

Nocturnal Incontinence of Urine. By M. Trousseau. 

We doubt the necessity or propriety of resorting to the apparatuses 
suggested by Mr. T. We have often relieved cases of this kind with 
Tr. of Iron, and other tonic medication. — [Ed. S. M. & S. J. 

M. Trousseau observes that the nocturnal enuresis of chil- 
dren and young persons takes place after they have been asleep 
one or two hours, and that they retain the urine during the 
rest of the night. As a possible explanation of this, he refers 
to the fact that there is erethism of the genital organs during 
the commencement of sleep; and asks then, whether there may 
not be a tenesmus of the bladder ? ' But, he further asks, why 
should not the sphincter then tend to retain the urine ? 

M. Trousseau speaks highly of the treatment by belladonna, 
as recommended by MM. Brettonneau and Morand. In al- 
most every case in which he has used it, he has found it suc- 

The organs must be caused to lose their bad habits; and 
this may be done by awakening the children after they have 

1853.] Nocturnal Incontinence nf Urine. 189 

slept an hour, in order that they may urinate. On the next 
night they are awaked a few minutes later, and the time of 
awakening is made later every night, until at last it is desisted 
from. This has sometimes effected a cure. 

At the same time, pills containing a centigramme of extract 
of belladonna are given ; a week after the quantity is raised to 
two, and then to three, rarely to five centigrammes. The child 
is now roused only on alternate nights, and if it has not wet its 
bed on those nights when it has been left asleep, it is not 
awakened ; if it continues free from enuresis for a fortnight, 
the dose of belladonna is diminished. If the case goes on fa- 
vourably, the treatment is alternately resumed and intermitted 
for some weeks, until it is finally left off. This is necessary, 
as the disorder may return after some months, in the manner 
of marsh fever. 

In cases of incontinence of urine, eczema of the vulva or 
prepuce may be produced by irritation of the urine : it may 
then extend to the meatus urinarius, and cause tenesmus of the 

If belladonna fails, the syrup of sulphate of strychnine is 
sometimes found useful. If these fail, flagellation and stinging 
with nettles may be useful, as instruments of intimidation, or 
perhaps they may have some reflex power. 

M. Trousseau finally describes an oval compressor, which 
he has devised for the treatment of nocturnal enuresis. 

An elastic band is fixed round the body, and supports at the 
back a spring which reaches to the anus. To this is fitted a 
metallic plate, on which is fixed a truncated cone of caoutchouc, 
two or three centimetres (about two-thirds to an inch) in diam- 
eter at the base, according to the age of the patient, and the 
amount of compression required. The pressure may be in- 
creased or diminished by introducing the cone more or less 
deeply ; and the size is varied by adding perforated shields of 
caoutchouc, in greater or less number, so as to diminish the 
length of the cone. Straps are passed under the thighs; and 
thus we have a light bandage, in no way inconvenient, which 
in boys acts in some way as a sphincter, by compressing the 
neck of the bladder and preventing the urine from escaping, 
and imparts to the bladder the habit of remaining full during 
the night as well as during the day. 

But as this method could only be applied in girls. \ 
nam, and then with great difficulty, M. Trousseau employs a 
modification of the instrument contrived by M. Gariel for ar- 
sting uterine hemorrhage. It consists of a caoutchouc bag, 
which is introduced beyond the hymen : by means of a tube 
it is inflated with air, and a stopcock attached to it is closed. 

190 Remedy for Indigestion. [March, 

The back presses on the lower part and neck" of the bladder ; 
and in the morning the instrument, having been emptied of air, 
is taken out and cleaned. — [London Jour, of Medicine. 

Remedy for Indigestion. By John Spukgin, Esq. 

Mr. Spurgin having from numerous trials upon his own case, 
which was one of most obstinate indigestion, and those of nu- 
merous patients and friends, found the following recipe of emi- 
nent service in their relief, he was determined, if possible, to 
give it a public recommendation, hoping that it might prove an 
instrument in our hands for the expulsion of quackery from 
some of the domains of our art. He says : 

This latter consideration weighed strongly to induce me to 
give the article a proper trial ; and I allowed the late Mr. 
South, of Hunter street, who was a general practitioner, to 
prepare and sell it, after having satisfied myself in my person, 
and with several of my dyspeptic patients, of its efficacy and 
undeniable utility. The widow of this gentleman has contin- 
ued to prepare and vend it, under the title of the " liquid condi- 
ment," for her own benefit, according to this formula: 

^. Liq. potassas ; sodii chloridi, aa 3 i. ; sodas phospha- 
tis, 3 iss ; aq. purae, I iii. 

As much of the solution may be taken at a time as will not 
affect the taste of the beverage disagreeably. 

In a great many instances the article has proved most useful; 
many families have it on their tables for daily consumption; 
and even make their tea by first putting two or three teaspoon- 
fuls into the tea-pot with the tea. 

It is not intended to be resorted to as an occasional remedy 
for various forms of indigestion, but constantly, in like manner 
as common salt. — [Med. Times and Gazette. Braithwaite. 

Treatment of Jaundice. 

Dr. Budd recommends the following treatment in cases of 
jaundice arising from suppressed secretion : 

From 3 ss. to 3 j. of sulphate of magnesia, in conjunction 
with gr. xv. of carb. of magnesia, and 3 ss. of aromatic spts. 
of ammonia three times a day, — the sulphate of magnesia to 
keep up free action of the bowels ; the carbonate of magnesia 
to neutralize any excess of acid in the stomach or bowels ; 
and the aromatic spirits of ammonia to support the nervous 
system, and to keep up the action of the skin. — [Med. Chir. 
Rev. Ibid. 

1853.] Sal Ammoniac in Enlarged Prostate. 191 

On the Administration of Sal Ammoniac in Enlarged Prostate. 
By M. Vanoye. 

M. Fischer, of Dresden, has long been in the habit of admin- 
istering this medicine, in large doses, in chronic enlargement 
of the prostate : and since lie published an account of his suc- 
cess with it in 1831, various other German practitioners have 
supplied corroborative testimony. Seeing that surgical treat- 
ment is so inefficient, this means would seem to supply a valu- 
able resource, and this especially as it may be employed in 
conjunction with other remedies. In the present paper, M. 
Vanoye relates two cases in addition, in which the success 
obtained seems quite to justify former encomiums. In both, 
the gland became progressively and greatly diminished in size. 
Large doses are, however, required. We may commence 
with fifteen grains every two hours, and go on to double or 
treble this quantity, so that nearly half an ounce is taken per 
diem. When the dose given is too great, we are admonished 
by disorder of the digestive organs, a miliary eruption, profuse 
sweats, and especially by scorbutic symptoms. These ill effects 
may be prevented or diminished by the employment of mucil- 
aginous vehicles, bitter extracts or aromatics, and a good animal 
diet. Persons suffering from hemorrhagic disposition, or affec- 
tions due to poverty of blood, should not be subjected to this 
treatment. — [Bulletin de Therap. Med. Chir. Rev. Ibid. 


Quinine and Veratrum Yiride in Typhoid Fever. — The gradual 
extension during the last few years of Typhoid fever from its former 
northern and mountainous habitations, to the warmer and lower re- 
gions of the Southern States, and even into Louisiana and Florida, is 
a remarkable fact in the history of this disease, for which it may be 
difficult to assign any satisfactory reason. Be this as it may, it is an 
interesting fact to the practitioners of these sections of country, many 
of the oldest of whom were never before called upon to treat this 
formidable atfection. The discovery of the jugulating effects of qui- 
nine in the management of our fevers, whether designated as inter- 
mittent, remittent, congestive, country or malarial, had robbed this 
most extensive class of Southern diseases of all its terrors. The 
physician rode triumphantly with quinine in his saddle-bags over the 
most pestilential districts, administering relief and cutting short with 
great certainty the most threatening attacks of the malady. The 
planter had learnt to do the same, so that by applying the antidote 

192 Miscellany. [March, 

upon the first indication of the effects of the morbific agent, this was 
at once neutralized, if we may use the expression, and our old-fash- 
ioned bilious fever (so called) had disappeared and become obsolete. 
Protected against the fatal effects of malarial fevers — unharmed by 
the scourges of colder climes, consumption and typhoid fever — the 
sunny South might well have boasted of its delightful and salubrious 
atmosphere. Such was the state of things when a new form of fever, 
gradually coming down from the mountains of North Carolina, South 
Carolina and Georgia, and reaching the terminus of the primitive 
geological formations, spread itself over the diluvial plains, inva- 
ding with more or less malignancy, cities, villages, plantations, pine 
barrens, prairies, valleys, and finally reached the sea-board of the 
Atlantic and Gulf of Mexico. 

Accustomed to the controlling influence of quinine in the manage- 
ment of the former types of fever, the physician and the non-professional 
citizen naturally resorted to this potent agent with great confidence, 
and did not abandon its use until they became convinced that the new 
form of fever would not be jugulated, but would run its course, despite 
of quinine and of every thing else. Yet, now that the expect- 
ant method of treating typhoid affections is generally adopted in this 
region of country, almost every medical journal bears to us intelli- 
gence from various points of the Union, as well as from Europe, that 
a great discovery has been made in the treatment of Typhoid fever, 
and that to quinine must be assigned the additional glory of arresting 
this as well as malarial fevers. 

We feel that our readers must be gorged to satiety with disquisi- 
tions upon Typhoid fever ; for very few of our numbers have been 
issued during the last two or three years without something on the 
subject, in the original or in the eclectic departments. But, when 
any one tells us that he can arrest the progress of Typhoid fever, 
whether by quinine, by veratrum viride, or by any other agent, we 
feel bound to listen to the facts and to place them before an enlight- 
ened profession, who may test them, and whose experience we would 
be pleased to learn, whether for or against the new remedies, when- 
ever sufficiently extensive and systematic to be of real value. Drs. 
Dundas, McEvers, Hayward, and others of Great Britain, have pub- 
lished their advocacy of the quinine treatment of Typhoid fevers in 
strong terms. In our country a number of practitioners have done 
the same, among whom we may name Prof. Th'os. D. Mitchell and 
Dr. Fenner. Dr. Norwood and others are equally decided in favor 
of veratrum viride. Itjs a question to be decided at the bed-side, and 

1853.] Miscellany. 193 

without reference to preconceived notions or theories. It matters not 
whether Typhoid and malarial fevers be regarded as identical or dis- 
similar in origin, cause or nature ; what ire need is a remedy — B con- 
trolling agent. Let us then weigh the question calmly and without 
prejudice — try fairly the plana proposed — and the truth will soon be 
determined. As conductor of this Journal, wo will side with neither 
party, but endeavor to keep our readers posted up as to facts. 

Reiaardfor the Discovery of Antithetic Agents. — From the docu* 
ments we are continually receiving, it is evident that the contest for 
Congressional remuneration for the discovery of the anaesthetic i I 
of Sulphuric Ether is actively carried on by the respective friends of 
Drs. Jackson, Morton, and Wells. We have taken some pains to 
look into the relative merits of the claimants, and would unhesitating. 
ly, were it in our power to do so, confer the reward upon Dr. Charles 
T. Jackson, as the first who really discovered and proved by direct 
experiment that insensibility could be induced by the inhalation of 
Sulphuric Ether. That Dr. Morton was very active in promulgating 
the knowledge he derived from Dr. Jackson, seems to be well estab- 
lished — but we feel equally well assured that if Dr. Jackson had nev- 
er made the discovery, Dr. Morton would never have been heard of 
in connection with it. 

Transactions of the Am. Med. Association. 
The Fifth Volume of the Transactions of the American Medical 
Association contains upwards of nine hundred pages of matter, about 
four hundred of which are allotted to Reports upon the epidemics of 
various sections of the Union. These are valuable contributions to 
the history of disease, but they will not interest the great mass of 
readers. These reports are preceded, however, by papers of intrin- 
sic merit and practical value, which all will read with pleasure and 
advantage. The first is the " Prize Essay," by Prof. Austin Flint, of 
BufFalo, on the " Variations of Pitch in Percussion and Respiratory- 
sounds, and their application to Physical Diagnosis." This, like the 
other writings of the distinguished author, evinces a discerning and 
logical mind of high order. The second is from the gifted pen of 
Prof. S. H. Dickson, of Charleston, " On the Blending and Conver- 
sion of Types in Fever'' — an exceedingly interesting document The 
third is u On the Action of Water on Lead Pipes, and the diseases 
proceeding from it," by II. Adams. M. D., of Waltham, Mass., and 
ought to be carefully read by all who reside in communities which 

1S4 Miscellany. [March, 

use water from lead pipes. The fourth paper is by Dr. George Hay- 
ward, of Boston, and treats of the "Permanent Cure of Reducible 
Hernia," but unfortunately teaches us nothing new upon this import- 
ant subject. Prof. Pope, of St. Louis, is the author of the Report 
upon " Water ; its Tropical uses in Surgery," which will be found 
full of practical utility. 

We regret that our limits will not permit us at present to notice 
these Transactions more at length. The price of this volume is $5. 
Complete sets of the Transactions can be obtained by remitting $25 
to Messrs. Blanchard & Lea, Philadelphia. 

Privileges of the Graduates of the Medical College of Georgia. — 
The Faculty of the Medical College of Georgia, having been informed 
that a doubt was entertained by some persons as to the exemption of 
the Alumni of this institution from the necessity of obtaining a State 
License to practice medicine, deemed it important to procure and 
to publish the opinion of an eminent jurist on the subject. The 
following communication from the Hon. A. J. Miller will, it is hoped, 
settle the question.' We add the section of the Statute now in force, 
setting forth the penalties incurred by those who may practice medi- 
cine without either the Diploma of the Medical College of Georgia or 
a State "License." 

"Sec. 11. If any person shall hereafter presume without such li- 
cense to practice physic, surgery, or in any manner prescribe for the 
cure of diseases for fee or reward, he or they shall be liable to be 
indicted, and on conviction shall be fined not exceeding the sum of 
$500 for the first offence, and for the second, be imprisoned not ex- 
ceeding the term of two months, one half of the fine to enure to him 
who shall inform, and the other half to the use of the State." — Cobb's 
Digest, p. 886. 

Augusta, February 15th, 1853. 

I have been requested to give my opinion upon the question, whether 
the Graduates of the Medical College of Georgia are required to un- 
dergo an examination before and to receive license to practise from the 
Board of Physicians. 

This inquiry, I think, is plainly and satisfactorily answered by the 
ninth section of the Act of 1828 (Dawson's Compilation, 196) incor- 
porating the Medical Academy (now the Medical College) of Georgia. 
That section declares that — 

"The Graduates of the Medical Academy shall be allowed to prac- 
tise Medicine and Surgery in this State, in the same manner as they 
would have been, had they been examined and licensed by the Board 

1853.] Miscellany. 195 

of Physicians of the State of Georgia; any law, custom or usage to 
the contrary notwithstanding." 

Considering the act of incorporation a contract between the State 
and Institution, and the section in question as giving a privilege con- 
ducive to the prosperity of the latter, I do not believe it to be in the 
power of the Legislature, by any subsequent act, to impair any part 
of the franchise conferred. The Legislature has not so intended ; 
for while, by the acts of 1829 and 1833, the name of the corporation 
has been twice changed, and by the last an outfit provided, the powers 
and privileges conferred by the original charter upon the College and 
its graduates have not been interfered with. 

It is true, that the Act of 1825, (Cobb's New Digest, 886,) prohibit- 
ing physicians from practising without a license from the Board of 
Physicians, has been revived by the Acts of 1839 and 1847 — yet, as 
the Charter of the College relieved it from the provisions of that Act, 
afterwards repealed, the revival of it cannot aflect the exemption 
previously granted. 


Attorney- at Lair. 

State Medical Society. — The Medical Society of the State of Geor- 
gia will hold its Fourth Annual Meeting in Savannah, on Wednesday, 
the 13th April next. Juriah Harriss, M. D., of Augusta, will deliver 
the annual address. It is hoped that a large meeting will assemble, 
as the transactions are expected to be of a very interesting character. 

D. C. O'Keeffe, Rec. Sec. 

Greensboro', Ga., Feb. 1853. 

Committees appointed by the President of the Medical Society of the 
State of Georgia. 

"Resolved, That a committee of three be appointed by the Presi- 
dent, for the purpose of proposing subjects for Essays to be pre- 
at the next annual meeting. 

M Retohedi also, That the President appoint eommittees of one for 
each of the Essays ab >ve referred to, whenever he shall have 
furnished with the subjects selected." 

In accordance with the above Resolutions the following subjects 
were presented to til' 1 President, who appointed as Reporters tin 
tlemen whose names arc annexed to the questions. If the committee- 
respond to the call thus made upon them, as we trust all will, the 
next meeting of the Society will be exceedingly interesting. 

196 Miscellany. 

1. On the relative liability of the White and African races to particu- 
lar diseases — especially to Hemorrhoids, Fistula in ano, Tetanus, 
Phthisis pulmonalis, Scrofula, Intermittent fever, Cataract, and 
death in case of traumatic injury of the brain. By Dr. R. D. 
Arnold, of Savannah. 

2. On the existing Laws of Georgia, relating to the Practice of Medi- 
cine, and the sale of Drugs, with suggestions for additional legisla- 
tion. By Dr. R. Q. Dickinson, of Albany, Baker Co. 

3. On the Topography and prevalent diseases, during the past year, 
of each Congressional District of Georgia. Dr. P. M . Kollock, of 
Savannah, for the 1st District ; Dr. Theophilus Stewart, of Colum- 
bus, for the 2d District ; Dr. G. F. Cooper, of Perry, Houston Co., 
for the 3d District ; Dr. W. N. King, ofRoswell, Cobb Co., for the 
4th District ; Dr. Robert C. Word, of Cassville, for the 5th District; 
Dr. Henry Hull, of Athens, for the 6th District ; Dr. C. J. Paine, 
of Milledgeville, for the 7th District; Dr. Marshall Andrews, of 
Washington, Wilkes Co., for the 8th District. 

4. Dr. J. Le Conte, of Athens — On the Medical Botany of Georgia. 

5. Dr. I. P. Garvin, of Augusta — Bibliographical Sketches of Drs. 
Antony, Abbott, and Lyman Hall ; Dr. C. W. West, of Savannah — 
Bibliographical Sketches of Drs. Waring and Richardsone ; Dr. 
C. B. Nottingham, of Macon — Bibliographical Sketch of Dr. Baber. 

6. Dr. H. Rossignol. of Augusta — On the Vital Statistics of the City 
of Augusta; Dr. W. G. Bullock, of Savannah — On the Vital Sta- 
tistics of the City of Savannah ; Dr. John Bacon, of Columbus — 
On the Vital Statistics of the City of Columbus ; Dr. J. M. Green, 
of Macon — On the Vital Statistics of the City of Macon ; Dr. J. F. 
Alexander, of Atlanta — On the Vital Statistics of the City of At- 

7. Dr. L. D. Ford, of Augusta — On Pneumonia, and Pleuropneumo- 
nia, as they have prevailed in Georgia of late years : their amalga- 
mation with Remittent fever ; and in what respects they differ from 
those diseases, as described by European and Northern writers. 

3. Dr. H. R. Casey, of Appling, Columbia Co. — On the Remittent 
peculiarity assumed by Typhoid fever in Georgia. 

9. Dr. L. A.* Dugas, of Augusta — On the best plan of treating Frac- 
tures in country practice. 

10. Dr. D. C. O'Keeffe, of Greensboro' — On the Epidemic Jaundice 
which prevailed during the past year in certain sections of Georgia. 

11. Dr. H. F. Campbell, of Augusta — On the administration of Re- 
medial agents per rectum. 

12. Dr. Tomlinson Fort, of Milledgeville — The names of regular 
physicians, and the number of irregular practitioners in each 

13. Dr. J. A. Eve, of Augusta — On the use of Anaesthetic agents in 
Obstetrical practice. 

14. Dr. W. E. Dearing, of Augusta — On the Virus of Serpents. 



Vol. 9.] NEW SERIES.— APRIL, 1861. [\u. 4. 

© r t g i n a I <£ o m m u n i c a t i o n . 


Observations on the Value of the Microscope as a means 
for the Diagnosis of Disease. By W. J. Burnett, M. D., 
of Boston. 

It would indeed be as much out of taste as it would be 
uncalled for, to offer an apology for an instrument by the use 
of which organic science has already made such signal advan- 
ces. Its claims being admitted, my object is to refer to some 
of the leading features of its value for the accurate diagnosis of 
disease both in and out of the body. 

But, in the discussion of this subject, the query at once 
arises, does disease always have a tangible material expression, 
and that too of a corresponding and invariable character? A 
negative answer to this opening question would be regarded 
by many as quite unphysical, not to say unscientific ; but, in 
the present state of our knowledge, I must consider it as the 
one by far the most correct. It is true, that it may be urged 
that in virtue of the great fact constantly before us, that vitali- 
ty has its expression only in organization which is tangible and 
capable of analysis, so must it be inferred that there is always 
a tangible expression of any perversion of that vitality. This 
view may be very scienti!:: in one sense: but in the present 
state of pathology it is not the one practically correct ; for 
there are many transitory morbid changes of the vital phe- 

\. 8. — VOL. IX. NO. iv. 13 

198 Burnett, on the Value of the Microscope [April, 

nomena, many abnormal conditions of the economy known as 
functional, which leave no traces behind in the material parts 
or organs in which they occur — at least as far as we can now 
detect, after the most thorough examination. The probable 
existence, however, of corresponding changes, in such instances, 
is not denied ; but, in a practical point of view, we stand the 
same as though they were even disproved to exist at all. 

Too high an estimate, therefore, must not be placed upon 
the value of intimate microscopical studies for the elucidation 
of pathological conditions and phenomena. It should also be 
borne in mind that, even had we in every disease a definite 
product on which we could lay our hands, yet, after all, we 
cannot thereby go beyond the physical peculiarities of the pro- 
duct in question, and these may be wholly inadequate to the 
morbid phenomena manifested ; for it is the same in Pathology 
as it is in Physiology, that the structure of an organ or a mate- 
rial part furnishes us no certain key to its ulterior vital condi- 
tions or relations. 

The practical value of the microscope then, in pathology, 
does not consist in hunting up the traces of obscure phenomena, 
but in accurately determining the differential character of well 
marked products. 

The question then arises, have the elements of these material 
products of disease, characteristics sufficiently constant and 
unvarying to make them objects of scientific study. That the 
correct answer to this query is an affirmative one, I shall now 
attempt to show by a reference to the histological relations of 
diseased products. 

The relations of Physiology to Pathology are such, that the 
latter seems but an erring condition of the former. On this 
account the elements of morbid products appear under the 
same laws as those regulating the production of healthy tissues. 
Morphologically speaking, therefore, pathological formations 
have no elements differing in kind from those of health. But 
the difference lies in their complete want of functional rela- 
tions : they subserve no adaptive economical purpose in the 
system, but are in one sense parasitic. These products, also, 
as superventions in and upon healthy parts, are necessarily 
infra formations — they are below the standard of those of 

1S53.] as a means for the Diagnosis of Disease. 

health of which they may, or may not, take on some of the 
characteristics. These elements are cells, colloid and granular 
forms, all of which wear the semblance of physiological ] 
As forthe cells, I may make here the general statement, founded 
on a pree >n, that, both as to their genesis 

eneral aspect as siny hich belong to the 

abnormal cannot be distinguished from those belonging to the 
normal products of the economy : that is, they are cells, and in 
both cases have all the requisite parts of these organs. Where, 
then, are the distinguishing features between these two classes 
of objects? I answer, not so much in the characteristics of 
their isolated as of the . jated forms, and in their local 

and functional relations to the parts in which they occur, or to 
the whole system gene or an exemplification of these 

points we will take up the three classes of heteromorphous 
pathological products, viz., Cancer, Tubercle, and Pus and 
pyoid forms: — Of these, cancer is the highest, and has most of 
the general peculiarities of healthy 

In ear! ranee in a distinct and unmistakable form 

\v cells, as I have often observed. We can trace 
it no farther back, but all analogy is in our favor for supposing, 
as is the case with tubercle, that these cells are formed in an 
unhealthy plasma effused from the blood. Moreover, on the 
inner surface of the testicular tubes, as I have sometimes observ- 
ed them just appearing, they seemed to replace the normal 
epithelial cells there situated, and to be formed like them. 
This cell, the first, is also the last or highest expression of this 
product, it being t. nal and not the transitional form. 

It is nucleated, and not unfrequently has several distinct nuclei; 
but, as t<> id other external characteristics, it has 

.nothi: and peculiar; and in my present 

opinion, no features by which it, taken alone, may always be dis- 
m other purely cell structures.* Formerly mv 

aide on the a of the microscope to 

.at the 

• , in a uiven case, 

specimen. I once took this 

o not thii He all ad • ) to the 

brilliant :. u .1 characteristic. But these 

ppeared to . J I have met with them 

norbid ce..^ in those c: | igenese*. 

200 Burnett, on the Value of the Microscope [April, 

opinion was, iike that of most of the microscopical pathologists 
then and now, that the cancer-cell, as such, has physical pecu- 
liarities by which it can always be distinguished from all other 
cells, healthy and diseased. But from a late and somewhat 
careful review of the subject, based, not only on observations 
of the cells as physical objects, but upon a consideration of 
them as constituting an expression of pathological action, I am 
free to confess that I do not now regard my former opinions 
as tenable. 

All, or nearly all the microscopical relations of the cancer, 
cell which have any claim of being peculiar to it alone, may, I 
think, be stated in the following brief manner : — When fully 
developed it is simply a nucleated cell ; it may, however, have 
several nuclei, or even none at all ; it is often of an irregular 
shape, fusiform, caudate, &c, &c, and its size is frequently 
equally variable ; but the evidence of its being not only of a 
pathological, but of what is called a cancerous nature, cannot, 
and does not, lie with any one of these points alone, but rather 
with a combination of them all, and that, too, united with the 
fact of its occurring in the tissues, and under circumstances 
where it cannot be regarded as a healthy product. Its dif- 
ferential diagnosis, which I think can be made out in nearly 
every case, depends upon these considerations which, when 
fully examined, will, I believe, be found amply sufficient. 

Suppose, for an illustration, a small bit of a cancerous tissue 
has been forwarded for microscopical analysis. I know no- 
thing of its history, locality, or other relations ; but I decide in 
the first place that it is not a normal product, from the fact that 
its cell constituents have no type peculiarities. As an hetero- 
morphous product, then, the diagnosis lies between its being 
tubercle, a pyoid form, or cancer. But as the two former are 
only celloid, and not true cell structures, the decision rests 
with its being cancer. Put upon these grounds, its diagnosis 
would always be attended with no difficulty. But the matter 
is not thus easily disposed of: the question arises, may it not 
be a homceomorphous non- malignant product of an epitheloid 
character ? In other words, can simple epitheloid formations 
be always discriminated from cancerous products occurring in 
the same locality ? This question has both an histological and 

1853.] as a means for the Diagnosis of Disease. 201 

a practical importance, and in gjving to it an affirmative an- 
swer, I know that I am expressing more than many pathological 
microscopists would allow. But my own experience sustains the 
correctness of this view. The distinction consists in the absence 
of all individual cell-type in the one (cancer), and the presence of 
it in the other (epitheloid epigenesis). The cells of cancer taken 
separately are simply cells — they present no invariable spe- 
cial or specific characteristics, as before remarked ; while those 
of epithelial tumors have the almost exact resemblance of those 
of normal epitheloid tissues. Meckel has, indeed, laid down the 
law, that morbid tissues assume the morphological characteris- 
tics of the normal parts with which they lie in contact ; and 
it might be argued, that, this law being true, cancer occurring 
in an epithelial tissue would be so epitheloid as not to be dis- 
tinguishable from a simple epithelial product. But, in my 
opinion, this law of Meckel holds true only of homacomorphous 
products, and cancer is distinguishable by its recklessness of 
these very governing laws. From these data, I think the expe- 
rienced eye can always, or nearly always, make out the differ- 
ential diagnosis in difficult cases of this kind. But here I may 
make the remark that, in the successful study of these forms, as 
is true of the study of Genera and Species in Natural History, 
the appreciation of differences is something not always easily 
described in detail, — seeming to consist in a faculty of judging 
from the tout ensemble of appearances, and which is acquired 
only from a somewhat extended study and observation. But 
we will carry out the application of these remarks somewhat 

There not unfrequently occur cases where it is all important 
to know positively, whether a certain disease is of a malignant 
nature or not, as bearing on the expediency of an operation, or 
on the prognosis of the case. The question is, does the micro- 
scope afford any positive and new data for the solution of such 
points ? In a majority of cases where a portion of the diseased 
tissue is accessible, I think it does ; and even where its data 
furnished are not sufficient of themselves, they maybe very 
great aids combined with others of a general and clinical char- 
acter. Thus, cancer of the uterus may be diagnosed accurate- 
ly from the escaped exudations which pass off through the 

202 Burnett, on the Value of the Microscope [April, 

vagina. This is true likewise of its occurrence in other organs 
where there is an escape of its elements externally. But in 
cases where the disease has no external communication, but 
lies concealed beneath healthy tissues, as is true with many 
tumors of the surface of the body, and must be reached by an 
exploring needle, the results thus obtained are less reliable and 
trustworthy. In the first place, one cannot be positive that the 
minute portion thus brought away is the real primitive disease ; 
and in the second, the quantity is so small that you cannot make 
that comparative examination necessary to afford a positive 
result, at least such a one as would allow T you, in any given case, 
to assert an opinion as to the nature of the disease, at variance 
with that founded on its locality and general history. But such 
examinations will furnish at least highly auxiliary data, and in 
many cases may serve as the turning point in this or that diag- 
nosis. The practical bearings of such examinations are some- 
times strikingly prominent as I have myself observed and 
wrought out in three or four cases ; but, unfortunately, they are 
generally less so than those of a scientific character. Usually 
the line of action of the practical surgeon is clear and distinct, 
based upon a resume of the general conditions of the case com- 
pared with past experience. He is, moreover, generally called 
upon in the advanced stages of the disease and when all other 
resources have failed, and then his decision to use the knife or 
not, is based more upon the constitutional condition of the pa- 
tient and the amount of disease, than upon an exact knowledge 
of its histological nature. 

But the chief value of microscopical studies of cancer, is after 
the diseased product has been removed. It is true, that such 
examinations have few or no practical bearings for the pa- 
tients from whom the disease is taken, but they are of eminent 
scientific importance for our most comprehensive knowledge of 
this morbid product. If, with a full history of its general and 
special relations, is united, in every case, an exact account of 
its histological nature, the whole has a scientific completeness, 
exactly as when a chemist with any mineral, gives, besides its 
locality. &c, its qualitative analysis. And when the annals of 
science shall have been made rich with such records, the prac- 
tical surgeon will proceed with an inductive certainty in his 

1853.] asameans for the Diagnosis of Disease. 203 

movements, quite unknown at the present time. The necessi- 
ty of such a line of strict inquiry will perhaps be the better 
appreciated if we bear in mind that the splendid labors of the 
older surgeons want a strict scientific value in this respect, 
from the absence of such histological analyses. Recent micro- 
scopical studies have shown that the general or gross charac- 
iCs of a disease form no invariable and certain index of its 
histological and real nature. Then again, depending entirely 
on gross appearances, why should the opinion of the most dis- 
tinguished surgeon be preferred to that of the most humble, as 
to whether a tumor is hard, soft, or grey, white or brown ? 
And surely, when Sir Astley Cooper or Velpeau have unhesi- 
tatingly and authoritatively pronounced this or that tumor to 
be a cancer, their opinion must, in reality, have been founded 
upon such arbitrary data as these. 

Many of these same considerations just made are applicable 
to the second morbid product in question — Tubercle. This is, 
however, a much inferior formation, being celloid rather than 
cellular. Moreover, it is connected with a much lower consti- 
tutional dyscrasia, and its local appearance, however small, is 
usually attended with general conditions of an unmistakable 
character. On this account, therefore, microscopical examina- 
tions are not very frequently required for the accurate deter- 
mination of this product in the living body. There are cases, 
however, when careful histological analyses are necessary to de- 
cide between it and the products of so-called chronic inflamma- 
tion. But here, as is the case with cancer, these analyses have 
now more of a scientific than a practical value ; for in all such 
cases, whatever maybe the scientific, yet the therapeutic diasmo- 
^uld be the same. This, the best of clinical experience has 
shown to be true. But the question occurs, has tubercle a 
characteristic element by which, with the aid of the micro- 
scope, it can be distinguished from other morbid products. To 
lery, I return an affirmative answer, in the same way and 
with the same qualifications as I have with cancer ; but at the 
same time, a diagnosis of this kind, with the same data, would 
have much more assurance than is true of the last mentioned 
product. This is so because its elements are colloid, and the 
product of a low inflammatory action, so that there are few 
others with which it can be well confounded. 

204 Burnett, on the Value of the Microscope [April, 

The distinguishing characteristics of the tubercle corpuscle 
belong to a low vital condition. When first formed, as I have 
observed in several instances in the lungs, it consists of a celloid 
body of about one two-thousandths of an inch in diameter, non- 
nucleated, but containing numerous granules : it is then perfect- 
ly spherical and has a very uniform aspect. But at this early 
period, and before they have formed a distinct visible product, 
these corpuscles are rarely seen. Most observations upon them 
are as found in distinct tuberculous matter taken in masses 
of various sizes from different organs. They then have a differ- 
ent, though not less uniform aspect ; they are smaller, their 
contour less regular, and on the whole they have a withered, 
shrivelled appearance. This change is due, I think, to a par- 
tial exosmosis of their previously contained liquid contents. 
Treated with acetic acid, the membrane or involucrum be- 
comes more transparent, thus rendering more distinct the 
granular contents of the corpuscle. Thus characterized they 
lie in the midst of broken parts of their like, together with a 
crowd of granules, all of which combined, form the solid con- 
stituents of the tuberculous mass. 

I think I do not estimate too highly these points, when I affirm, 
that with such data the experienced microscopist can pretty 
positively decide whether or not a product in question is tuber- 
cle. But even were he in any given case, unable to return a 
positive decision, this would have very little practical import- 
ance, for the products at all likely to be confounded with it, are 
those of also a low inflammatory nature, and referible to the 
same line of pathological action. 

There are cases, however, though confessedly few, where, 
during the life of the patient, the microscope may be of much 
service in fixing positively the diagnosis of tubercular disease. 
Such are cases where this disease has some internal seat, but 
communicates externally by a fistulous or other opening. The 
best instances of this kind are cases of tuberculosis of the bones, 
and several times I have had the satisfaction of accurately de- 
termining this disease thus concealed, simply from its exuded 
puriform portions escaping externally through long fistulous 

But in truth, as has just been said of cancer, microscopical 

1853.] as a means for the Diagnosis of Disease. 205 

studies of tubercle have, at present, more of a scientific than a 
practical value. Occasions are constantly occurring during 
post-mortem examinations, where it is both interesting and im- 
portant to accurately determine the nature of larger or smaller 
diseased products accidentally or otherwise met with in the 
various internal organs. Such decisions are often of much 
scientific value, as bearing upon the doctrines of the concomi- 
tancy or antagonism of certain diseases. Such examinations 
are all the more worthy of attention, from the fact, that on the 
surfaces, or in the parenchyma of internal organs, there are 
constantly formed from various accidental inflammations, 
lymph-like and other products so closely simulating in gross 
aspects tubercle, as to be easily taken for it. But I need not 
pursue this line of consideration farther, for the various import- 
ant bearings of such analyses will be readily suggested to those 
at all familiar with these studies. I will add only, that the con- 
fidence and satisfaction which the necrotomist has under such 
circumstances, constitute one of the pleasantest relations in this 
department of microscopy. Like the chemist in his laboratory 
with minerals before him, he need not dwell with uncertainty 
upon the doubtful aspects of a product at his hand. 

In regard to pus and pyoid corpuscles, they need not claim 
much of our attention with the relations under discussion, — they 
are the products of inflammation alone, and, in my opinion, 
inflammation never occurs without their being formed to a 
greater or less extent. Their microscopical appearances are 
too well known to be here described. The highest form, the 
pus corpuscle, however, is very uniform in its size and general 
appearance, full as much so as that of tubercle. It is the high- 
est or ultimate product of common inflammation, and is ob- 
served in its most perfect form in the so-called "laudable" pug 
which is richest in plastic material. In the majority of in- 
stances its gross characteristics are sufficiently indicative of its 
exact character. But there not unfrequently occur cases n 
which the microscope serves as a happy and positive aid. Such 
are instances where it is concealed in some other product, as the 
urine, the feces, and effused liquids into any of the cavities of 
the body. I need not here enter into detail to show exactly 
how this aid is rendered, but instance after instance might be 

206 Burnett, on the Value of the Microscope. [April, 

quoted illustrating how, by such examinations, an internal 
latent inflammation has been positively diagnosed when wholly 
inaccessible by any or all of the common symptoms, if perchance 
they were present. 

As to the so-called " pyoid forms," their practical microsco- 
pical relations are still more prominent: They consist of 
rudely-made granular corpuscles of variable size, though in other 
respects of a pretty uniform aspect ; they are easily distin- 
guished from the well-formed pus-corpuscle by this ill-con- 
ditioned structure. I regard them as the transitory forms 
between the tubercle and pus-corpuscles, if the present state of 
our knowledge of these products and their relations will allow 
the admission of any such transition. Indeed, the study of the 
tout ensemble of their appearances in comparison with tuber- 
cle, has had no small weight in the formation of my opinion 
that this last is truly an inflammatoid product. Wherever oc- 
curring they are the results of an inflammatory process alone, 
and that too where the effused blastema is of a very low order. 
On these accounts great value may be attached to their pre- 
sence which, by the way, generally occurs under circumstances 
otherwise obscure ; and then the question of inflammation on 
other premises cannot be raised. They are met with in dropsi- 
cal fluids of any source, as those of hydrocele, cystic disease 
of the ovary, ascites, &c, — also in organs laboring under a 
chronic inflammatory process, at least where the inflammation 
is of an indolent instead of a suppurative character. A well- 
marked instance of this last, and where too the microscope is 
of signal aid, is that low form of nephritis known as Bright's 
disease : for, according to my own observation, their successive 
presence in the urine is almost invariably diagnostic of this 

A consideration of the practical value of the microscopical 
study of the homoeomorphous products of disease, as well also 
as that of the morbid changes of the solid constituents of the 
blood, must here be omitted for another time. 

1853.] Foote, 07i Fracture of the os Fronds. ^0? 

artici.i: xiv. 

Fracture of the os Frontis — loss of cerebral matter — Recovery, 
By K. T. Foote, M. D., of Society Hill, Ala. 

On the ISth of August, 1851, 4 o'clock, A. M., I was called 
in haste to the plantation of Mr. M. J. C, of Macon county, 
Alabama. On arriving, I found a negro woman in the follow- 
ing condition : Total unconsciousness, not being able to arouse 
her by the loudest calls; stertorous breathing ; general paral- 
ysis — evidencing no sign of sensibility even when severely 
pinched; coldness of skin; pulse slow and feeble; pupils 
dilated, insensible to the strongest light, etc. ; bloody water 
oozing out of ears. 

One and a half inches above the left orbitar plate there was 
an external wound of two inches in extent ; superiorly to this, 
one inch below the coronal suture, another, about one and one- 
fourth of an inch long — each extending in a line parallel with 
the above mentioned suture, that is, transversely across the 
cranium. A considerable portion of cerebral matter was lying 
in immediate contact with her head. Beneath these wounds 
the frontal bone was severely fractured and much depressed. 
By way of explanation, I will add, that this injury was inflicted 
by a negro man giving her two heavy blows with the pole of 
an axe: the woman was asleep at the time. 

This being a very serious case, I requested a consultation. 
Doctor W. was accordingly called in. The treatment, of 
course, was to remove the compression as soon as possible ; 
we therefore commenced removing the detached pieces of 
bone, and soon took away seven pieces. Two of these were 
very large, the others small — putting them together they will 
measure at least three inches square. We ligated but one 
small artery, a branch of the external temporal, the loss of 
blood not exceeding *^0 oz. After removing all detached spic- 
ula? of bone and cleansing the parts of blood, we found the 
dura and pia membranes punctured in several places; in fact, 
the whole appeared to be reduced to a pulpy mass. Thi 

.' wound was then closed by the uninterrupted suture. 
Immediately after removing the largest pieces of bones, the 
patient's sensibility began to return, evidence of which she 

208 Foote, on Fracture of the os Fronds. (.April, 

gave by her deep groans and movements. We ordered cold 
cloths to be kept constantly applied to her head, renewing 
them every fifteen minutes ; perfect quietude, &c. 

The following is merely a transcript of notes recorded at 
each visit : 

August 18, 6 o'clock, p. m. Appears to be a little conscious, 
making some attempt to answer questions when interrogated ; 
passed urine ; pulse 85 ; restlessness; continual moving of ex- 
tremities. Same treatment continued. 

19th, 8 o'clock, a. m. Nurse reports she slept six hours 
during the night ; drank water and some water-gruel. Pulse 
80, no fever perceptible ; left eye blood-shot. Her infant child 
being presented to her, she took and nourished it. 6 o'clock, 
p. m., sensorial functions remain the same, pulse varying from 
70 to 75. Treatment continued. 

20th, 8 o'clock, a. m. No special alteration from the 19th, 
only in the pulse, which is now 60. Same treatment, with the 
addition of a bolus of calomel and jalap aa 10 grains. 

21st, 9 o'clock. Pulse 62; voice more distinct; appears to 
be conscious of her condition and the cause of it ; complains 
of great pain in occipital region. 

22d, 10 o'clock, a. m. Pulse 70 ; sensorial functions the 
same. Having noticed a free flow of saliva and difficult deglu- 
tition for several days, I examined her particularly, and found 
upon pressing on the left side of the inferior maxillary bone, it 
gave her great pain ; breath quite offensive; tongue and cavity 
of the mouth covered with yellow pimples. Ordered her to 
have sulphate magnesia, to keep her bowels open, etc. . 

23d, 9 o'clock, a. m. General restlessness ; pulse 75 ; occa- 
sional pain in sinciput region; contraction of features ; water 
running from left eye ; face much swollen. 

24th, 8 o'clock, a. m. A fair night's rest ; very calm and 
quiet ; countenance more natural. 6 o'clock, p. m. Slight fe- 
ver this evening, supposed to be caused from excitement of 
company. Again gave orders to keep her perfectly quiet, with 
the same general treatment, viz. cold to the head, saline purga- 
tives, water-gruel, &c. 

25th, 6 o'clock, p. m. The offensiveness of the breath in- 
creased ; great difficulty in swallowing ; pulse 80, rather full. 
Same treatment, with an astringent mouth-wash. 

1853.] Dugas's Cases. 209 

26th, G o'clock, p. m. Pulse 75, full and soft ; complains of 
great pain in the space between the helix of the left ear, and 
articulation of the inferior maxillary bone ; pus mixed with 
sputa, noise disturbs her much. 

27th. Much better to-day. Unfavorable symptoms of yes- 
terday moderated. 

28th. Still improving ; pulse nearly natural ; no symptoms 
of inflammation. 

20th. Conversation rational and tolerably distinct ; recol- 
lection good ; complains of but slight pain. Requests stronger 
diet. Healthy suppuration from external wound, with the ex- 
ception of two small places, from which issued sanious fluid. 
A few granulations of fungous growth shooting up. These 
destroyed by burnt alum, cicatrized in a few days. 

I continued to visit this patient for several weeks. Nothing 
further occurred worthy of notice. I will only add, she con- 
tinued to improve rapidly, and is now in quite good health. 

The space from which the bones were removed has now for 
its covering the common integuments of the scalp. By placing 
your hand in immediate contact with that portion of the head, 
you feel a strong pulsation synchronous with that of the heart. 
The edges of the bone can be sufficiently felt to trace out the 
extent of the fracture. 

This woman suffers no inconvenience from the injury, when 
cool and quiet ; but when over-heated or much excited, a 
determination of blood to the head takes place, producing 
blindness, giddiness, etc. 


Two Singular Cases — Reported by L. A. Dug as, M. D., &c. 

The following cases are related merely as accidents of a 
singular character : 


A negro boy about 14 years of age, belonging to Mr. L. P. 
D., was riding a mule, harnessed as usual upon our plantations 
for ploughing, when the animal took fright, started off at great 
speed and dismounted his rider. In endeavouring to maintain 

210 Dugas's Cases. [April, 

his position, the boy clung closely to the neck of the mule, but 
finally slided off on one side. It so happened that the trace was 
suspended to the back band by means of a stout iron hook, 
which, as the boy glided over it, caught him by the scrotum 
and completely tore out his left testicle, which was found upon 
the hook when the mule was captured. 

The boy was sent to the city, a distance of eleven miles, and 
placed under my charge. The injured side of the scrotum 
looked as though it had been laid open longitudinally with a 
dull cutting instrument ; the cord was retracted and yielded no 
hemorrhage ; the boy stated that it bled freely at first, but 
soon ceased to do so. The edges of the wound were carefully 
brought together and secured with adhesive strips. No un- 
pleasant symptoms ensued ; union was effected by first inten- 
tion ; and in a few days the patient returned home perfectly 

A negro woman owned by Mr. B. P., was in the street 
near the market-house in this city, when a cow, in endeavor- 
ing to escape from dogs who furiously pursued her, encountered 
the unfortunate woman, thrust a horn into her mouth and tore 
open the cheek of her left side, from the angle of the mouth up 
to the masseter muscle. 

The edges of the wound were brought together by means 
of interrupted sutures and adhesive plaster, and union by the 
first intention was obtained without farther difficulty. The 
face now shows a merely linear cicatrix and is not disfigured. 

A friend, on hearing of this case, informed us that one of his 
servants was standing before an ox and endeavoring to adjust 
the yoke, when the animal suddenly throwing up his head, 
caught one of his horns into the man's nostril and hoisted him 
into the air, very much to the merriment of the by-standers, 
for he was not much injured. Sancho Panza was assuredly 
never in a more ludicrous predicament. 

1855.] Ricord's Letters on Syphilis. 211 


(Eclectic Department. 

Letters upon Syphilis. Addressed to the Editor of L'Union 
.Modi call', by P. Rioobd. Translated from the French, by 
D. D. SlAdb, M. D. 

[Continued irom Page 151.] 


My Dear Friend, — It is my purpose to-day, as I promised 
you, to see if it is possible to distinguish a simple blennorrhagia 
from one with a chancre concealed in the urethra. You see 
that I lay down the problem as boldly as my opponents. 

In the study of this diagnosis, it is important to establish two 
conditions; the one a diagnosis absolute, unequivocal and un- 
deniable ; the other a rational diagnosis. 

An absolute diagnosis cannot be obtained but by artificial 
inoculation. Every time that muco-pus furnished by a mucous 
surface will give the characteristic pustule, which we will soon 
have to examine in studying chancre, we can affirm, whatever 
has been the duration of the disease, that this muco-pus is viru- 
lent, that there is a chancre somewhere ; the chancre alone 
being able to give rise to the positive results of inoculation. 
is the incontestable fact established by my researches, and 
the absolute and unequivocal diagnosis in all its strictness. 

When by the inoculation of muco-pus from the urethra you 
obtain the characteristic pustule — pronounce boldly, and with- 
out the possibility of error, it is a virulent blennorrhagia. But 
only ask of inoculation, as of all the other means of investiga- 
tion, what we have the right to expect from it. We must have 
variolic or vaccinal virus to produce the effects of variola or 
vaccine. If at the side of a variolic or vaccinal pustule an 
abscess is developed, and you should take the pus from this 
abscess to inoculate, you would not obtain the specific effects 
of the vaccine nor of the variola. Take some muco-pus in the 
neighborhood of a variolic pustule developed upon the Schnei- 
denan membrane, and this muco-pus will not give the effects of 
the variolic pus. 

If you have, then, a patient actually affected with an urethral 
chancre, and at the same time with a simple blennorrhagia (a 
frequent complication), and in the place of taking the pus from 
the chancre, we take it from the blennorrhagia, the result will 
be necessarily negative. It does not require much mind to 
understand so simple a thing, and I am astonished that M. Vidal, 
who has much esprit, should make of this an objection against 

212 RicoriTs Letters on Syphilis. [April, 

inoculation. I have too high an esteem for his understanding 
to admit that he could believe that pus furnished by chancre 
of the urethra, when a blennorrhagia coexists, ought necessa- 
rily to be mixed with all the blennorrhagic pus ; or that a drop 
of pus from a chancre, acting after the manner of leaven, ren- 
ders the other necessarily virulent. Without doubt, the com- 
plication of morbid elements, as regards the diagnosis, often 
renders the analysis difficult, but an exact knowledge of each 
of these elements permits us, under any circumstances, to dis- 
tinguish between them. 

The chancre of the urethra, which can never have a very 
great extent or large surface, can furnish but a very small 
quantity of virulent pus. Even in the indurated chancre the 
secretion is sometimes almost nothing, generally insufficient to 
stain the linen of the patient. A very fine example of this can 
be seen at this moment in No. 15 of the first ward of the Hos- 
pital duMidi. 

Every time, then, that we have to deal with a very abundant 
discharge, we have the right to suppose that there is something 
else besides the product of chancre. We must guard against 
concluding upon the absence of chancre in the urethra, from 
the negative results of inoculation. But if the inoculation is 
repeated several times — if, moreover, care has been taken to 
press out the secretion of the urethra in order to obtain the 
more immediate product of the ulcerated surfaces — and the 
results have always proved negative, there is a very great pro- 
bability that it is a simple blennorrhagia and without the com- 
plication of chancre. Without doubt the diagnosis here is 
neither absolute nor complete ; but does it not present at least 
something more than the diagnosis which is generally made? 

In order to draw a conclusion from the negative results of 
inoculation, the epoch at which the experiment is made must 
be kept strictly in view. We shall see later, in studying the 
chancre, that the virulent secretion has a term, and that there 
is a moment when the ulcer passing into the state of simple 
ulceration ceases to furnish specific pus. If, then, experimenta- 
tion is made too late, less can be concluded from the negative 
results, than if the inoculation had been made during the first 
or second week following the infecting coitus. 

In examining inoculation under this point of view, does it not 
offer all that strict reasoning can demand ? If the results are 
positive, this gives you the most absolute sign that diagnosis 
can give. If they are negative, the results conduct then to a 
rational diagnosis of which they may be the most valuable ele- 
ments. Let a more sure or a more fruitful sign in human pa- 
thology be found. What ! would not that be a sign of great 

1853.] RicorcVs Letters on Syphilis. 213 

importance, which, when it exists, permits US to affirm, in a 
necessary inevitable manner, the existence of a lesion with 
grave consequences, and which, when not existing, can conduct 
us with a sort of certainty to a rational diagnosis! 

And because this sign has also its uncertainties, shall we not 
pay attention to those circumstances in which it presents a 
value and a mathematical precision? Are we, then, so rich in 
absolute diagnosis, that we ought to show ourselves indifferent, 
sceptical, or scorners with regard to a sign the existence of 
which smooths over so many difficulties? 

What other means but inoculation, in a case of legal medi- 
cine, will permit us to state strictly that a blennorrhagia is or is 
not symptomatic of chancre? 

But is it asked of me if inoculation is always applicable? Do 
we always arrrive in time? Can we and ought we always 
to count upon it ? Must we always have recourse to it ? Cer- 
tainly not; I have written this and repeated it a hundred times 
in my lectures, and it is incredible that objections should be 
again silted over that I have myself so many times made. In- 
oculation, since it is again necessary to repeat it, is an excellent 
means of diagnosis, but of which we are often deprived. Is this 
a reason for renouncing the research into the distinctness be- 
tween simple and virulent blennorrhagia ? Without doubt, no ; 
and fortunately, a well-directed minute study of all the ele- 
ments of the disease, gives, in the great majority of cases, 
whatever my opponents say, a diagnosis sufficient to enable us 
to conclude upon the prognosis, and to furnish the indications 
of a treatment truly methodical. 

It is not sufficient, as we shall see later, merely to have a 
primitive ulcer in order to fear the constitutional verole, and to 
necessitate a mercurial treatment ; other conditions are ordina- 
rily sufficiently well marked to enable us to recognize them. 

Permit me then, to pass over again very briefly in review, 
the ordinary elements of the diagnosis of blennorrhagia, of 
which there has already been a little question, on account of 
the etiology. 

You recollect what I said of women considered as a focus of 

infection, and the value which we can attribute to the source, 

gards concluding upon the virulence or the simplicity of 

orrhagia. The patients have a singular naive t^ upon 

this point, and entertain a strange idea of morality. How 

many times have I Been young people enter my office an..! 

to me — the blennorrhagia winch 1 ha be other- 

than benign, lor I contracted it from a married woman, 

the w i-. and I am very sure that it cannot 

be anything more than an * cm ; feme at. At this I am accus- 

x. 3. — VOL. IX. NO. iv. 14 

214 RicoroVs Letters on Syphilis. [April, 

tomed to answer — Sir, if your wife had a lover, would you consi- 
der her as a very honest woman? This question troubles almost 
all of them, and they see very quickly that in order to settle 
upon my diagnosis, I have recourse to means rather more cer- 
tain than the morality of the source. A woman perfectly 
healthy, I have already said, may be a source of infection. 

Among the curious and singular facts which have passed 
under my eyes, permit me to relate to you the following, which 
has also its morality, as you will see. A young and small 
household had invited to breakfast a friend of the husband. 
The repast was almost terminated, and the appetite was not 
satisfied. It was decided that a morsel of cheese should be 
added to the feast. The husband leaves the table, descends 
four pair of stairs, and runs to the neighboring grocery to seek 
the complement of the friendly repast. Alas ! he does not re- 
turn sufficiently quick. During his short absence, and between 
the pear and the cheese, his unfaithful better half committed 
adultery with his perfidious friend. The husband returns, the 
repast is finished, coffee and its accompaniments are taken, the 
friend retires, and the husband in his turn consummates the 
conjugal act. Three days after, the husband comes to me 
with a chancre of the urethra, with symptoms of blennorrha- 
gia. He was accompanied by his wife, and he assured me that 
he had had relations with no other woman. The most careful 
examination of the genital organs of that woman did not per- 
mit me to discover any thing suspicious. My prescription 
made, these individuals went away, leaving me without expla- 
nation of this virulent blennorrhagia of the husband. But the 
next day the wife returned, to ask me if I was very sure that 
she was not diseased. I examined her anew, and again I af- 
firmed to her that she was perfectly well. Then she related to 
me the history which I have just told you, and she added that 
the delinquent was there, and begged me to examine him. I 
found upon him a magnificent chancre on the corona glandis, 
in the specific period. 

This fact confirms the curious experiments made at the 
Lourcine by my young and learned colleague M. Cullerier. He 
placed some virulent pus in the vagina, let it rest there during 
some time, took it again upon his lancet, and inoculated with 
positive results, and the vagina, submitted to the treatment of 
injections only, was not infected. 

You will conclude with me, my dear friend, that the source 
from which the cause of the blennorrhagia has been taken, can- 
not give a great value to the diagnosis. 

I shall not return to what I have said of incubation as a means 
of diagnosis. The chancre of the urethra is sometimes devel- 

1853.] RicorcCs Letters on Syphilis. 215 

very quickly, and can furnish pus at an early period. So 
that, far from considering the blennorrhagia as virulent which 
has taken more time to appear, it is the contrary that we must 
very often admit. 

The violence of the blennorrhagia has been made a synonyme 
of the virulence. In truth it is just the contrary. As a gener- 
al rule, it is those cases of blennorrhagia which are the least 
violent, the least painful, which ought to give us the most fear 
of the existence of a chancre in the urethra. The duration of 
the discharge is a sign not to be neglected. It is not the dis- 
charges the most tenacious which make us fear the existence of 
a chancre in the urethra. The nature of the secretion has 
great value when we know how to appreciate it. The secre- 
tion which is the result of an ulceration of the urethra, is much 
more purulent than mucous ; it is ordinarily sanious, rust-color- 
ed, and charged with blood ; the least pressure, moreover, upon 
the urethra, renders these characteristics very sensible. But 
to give to this symptom (the presence of blood) all its value, 
we must be certain that the patient has not previously used a 
caustic injection, that foreign bodies have not been introduced 
into the urethra,or that he has not had a rupture of the canal 
during chordee; and that, moreover, sanguinolent matter is 
not expelled with the last drop of urine, in which case it would 
be the sign of cystitis with vesical tenesmus. 

I do not speak to you of the speculum for the urethra as a 
means of diagnosis of the ulcerations of this canal. It is an 
ingenious method, which has not given what it promised. It 
is sufficient sometimes to distinguish chancre, situated even at 
a considerable depth in the urethra, to cause the meatus to gape 
by stretching open the lips. Wedkind had thought that he 
found in the enlargement of the follicles in the neighborhood 
of the urethra, near the fraenum, a symptom of virulence; but 
these enlargements are generally only phlegmonous, and inde- 
pendent of every other complication* 

The most important symptom consists in the engorgement of 
the canal, especially in the region of the gland, the most fre- 
quent seat of chancre in the urethra. 

I have already said, that it is not so important to be able to 
state the presence of an ulceration, either by the aspect and the 
nature of the secretion, or by inoculation, as it is to know if 
one is concerned with an ulceration capable of determining the 
syphilitic infection. It is this that all authors have had in view, 
when they have spoken of virulent blennorrhania. 

Well I as we shall soon see, it is the indurated chancre which 
is the fatal antecedent of the constitutional verole. ZVow no- 
thing is generally more easy to prove than the presence of an 

216 Ricord's Letters on Syphilis. [April, 

indurated chancre of the urethra with symptoms of blennor- 
rhagia. If a blennorrhagic complication does not exist, the 
patients scarcely suffer in micturition ; the jet of urine is gen- 
erally twisted and troubled by reason of the diminution of the 
calibre of the urethra ; the erections are not painful, when the 
chancre is seated in the region of the gland. 

In order to well ascertain the presence of these ulcerations, 
it is necessary to explore the urethra by the aid of pressure 
which is exercised from above downwards, from the dorsal face 
to the inferior, as when we wish to make the meatus gape. In 
exercising this manoeuvre, w r e perceive a cord, more or less ex- 
tended, that some writers on syphilis have designated under the 
name oicorde balanique. It is easy to ascertain, in the great- 
est number of cases, the side of the canal upon which the 
ulceration is seated. Independently of the indurations plainly 
limited upon one side, we see that side form a convexity, whilst 
the healthy side separates in forming a crescent. When the 
pressure is exercised from right to left, nothing is felt, the indu- 
ration ceases to be appreciable. 

Doubtless the swelling in the region of the gland or of the 
follicles may be only the result of a simple inflammation with- 
out virulence ; but to complete the diagnosis we must have 
recourse to the accessory symptoms. Thus the affections of 
the glands are very rare in the blennorrhagia non-symptomatic 
of chancre. When they take place, as I have already pointed 
out, they are acute, terminate easily by resolution, or when they 
suppurate, it is simple pus that they furnish. 

With the urethral chancre, dorsal lymphangitis of the penis 
and the affections of the glands are much more frequent. If 
the chancre is non-indurated, the glands suppurate almost inevi- 
tably, and when the seat of the pus is opened, the suppuration 
furnishes incontestable marks of virulence. In the indurated 
chancre of the urethra, which is .the most important to recog- 
nize, the affections of the glands are inevitable and necessary ; 
several glands are affected at once, and they remain indolent 
and do not suppurate — upon all which conditions, I shall have 
occasion to return hereafter. 

Finally, if all these conditions have not been appreciated — if 
these signs have not been seized upon, either because we have 
arrived too late or because they have been overlooked, we can 
have the certitude, that if the patient has been attacked with 
blennorrhagia symptomatic of chancre, six months will not pass 
without the appearance of the accidents, if the constitutional 
affection has taken place. 

We shall have next to examine whether, as a last resource, 
it is not better to wait this length of time to give a diagnosis, 

1853.] RicorcVs Letters on Syphilis. 217 

than to cause the patient to undergo, during the same period, 
a mercurial treatment which, alter all, does nut allbrd mure 


My Dear Friend, — If I could think that your readers had 
remarked the interruption of my correspondence, and espe- 
cially if they had complained of it, I should ask of you the 
permission to have me excused, on account of other imperious 
duties which have taken up the few and short instants which 
I could devote to you. I could easily contract the pleasant 
and charming habit of these periodical conversations with the 
numerous public, that your talent and that of your fellow la- 
borers have known how to invite around your Journal. But 
you are so rich and so varied in this respect, that my absence 
could not cause any loss. I shall, however, do all in my power, 
in order that the good will of your readers may hereafter ac- 
company me at least as regularly as possible. 

I wish to terminate to-day what concerns blennorrhagia, by 
some words upon its treatment. You understand that in these 
letters, details would be idle and useless. I confine myself to 
generalization of all these questions, the developments 
making the subject of a special and extended treatise, which I 
soon hope to be able to offer to the judgment of my friends. 
Here, I touch upon all the doctrines of the Hospital du Midi, 
and I ought to conclude that which treats upon blennorrhagia 
by some considerations upon the treatment of this disease. 

When we see the obstinacy of certain writers on syphilis, in 
retaining the old ideas concerning blennorrhagia, recognizing 
and admitting only virulent blennorrhagia, it would seem that 
these writers ought not to establish the existence of any dis- 
charge without applying as soon as possible a mercurial treat- 
ment. But, it is not so. The greatest number of them content 
themselves with a rational treatment, and among them you 
will range M. Vidal, who does nothing but what I do. and 
perhaps less, fur in what he has written upon blennorrhagia, 
although establishing nowhere, an absolute differential diagnosis 
between virulent and benign blennorrhagia, he does not speak 
at all of the antisyphilitic treatment properly so called. Look 
at the Treatise on External Pathology by M. Vidal, and you 
will be astonished like myself, that with his ideas upon the 
virulence of blennorrhagia in general, the treatment of my 
Colleague sh<uild be so benign. 

I have already said a word upon the astonishing and ridicu- 
lous custom of those who give copaiba and cubebs for the 

218 Ricord's Letters on Syphilis. [April, 

blennorrhagia of bachelors, and who reserve mercury for who- 
ever wishes to marry. This mode of therapeutics with two 
aims recalls to me the history of one of my old colleagues of 
the Hospital du Midi. He had in his youth, like many others, 
contracted blennorrhagia. At a later period he was to marry 
the daughter of an old writer upon syphilis, who was imbued 
with the doctrines of the treatment of precaution ; he did not 
obtain the hand of his intended except upon the condition of a 
long-continued treatment with the liquor of Van Swieten. 
The treatment finished, the marriage is accomplished — all those 
who lived in intimacy with this colleague, and even those per- 
sons who were present at his clinical lectures, might have heard 
his frequent and bitter recriminations against this treatment of 
betrothal. As to the rest, this treatment has been very useless 
in the case of our colleague, for he had preserved an habitual 
discharge from the urethra, a last and peremptory argument, 
which he was in the habit of presenting to the individuals 
whom he did not succeed in curing of a similar inconvenience. 

Others, more logical in appearance, in admitting the virulent 
blennorrhagia, and confessing nevertheless that they cannot 
distinguish it from the benign blennorrhagia, give at all hazards 
and notwithstanding, a mercurial treatment. Hunter is of this 
number, and his manner of reasoning upon the treatment of 
blennorrhagia is very curious. If Hunter had no other title to 
the thanks and the admiration of the wise, his writings would 
not have come down to us, and M. Richelot, your learned and 
modest collaborator and friend, would not have gifted France 
with his beautiful translation of the works of the great English 
physiologist. Let us hear Hunter. The following passage is 
not foreign to the question: — 

" Whatever may be the method adopted for the treatment 
of gonorrhoea, whether locally or internally, we must not lose 
sight of the fact that a certain quantity of the matter of the 
discharge can be absorbed, and show itself afterwards under 
the form of constitutional syphilis. To guard against this effect, 
I think that small doses of mercury ought to be given internally. 
It is not easy to determine at what epoch this mercurial treat- 
ment ought to commence ; but if it is true, as I have before 
explained, that the syphilitic diathesis once formed cannot be 
cured by mercury, while this therapeutical agent has the power 
to prevent a similar diathesis from being established, it is im- 
portant that it should be commenced early, and should be con- 
tinued until the end of the disease, not only until the secretion 
of pus has ceased, but also some time after. Mercurial frictions 
can be employed, when the stomach and intestines cannot 
support the medicine. 

1853.] RicoriVs Letters on Syppffi*. 219 

"This practice is much more necessary, if the discharge has 
existed for a long time, especially when the treatment is com- 
posed of simple evacuants only. In fact, when the discharge 
IS of long duration, the absorption has mure time to exercise 
: and when recourse has been had to evacuants only, 
there is more reason to fear that this has taken place, inasmuch 
as this treatment has no faculty to expel the virus from the 

" To prevent the establishment of a constitutional virus, the 
consequence of the absorption of the venereal pus, it suffices 
to prescribe a grain of mercury every evening, or morning 
and evening : but it is necessary to continue the employment 
of it in proportion to the duration of the disease. 

"The success of this practice can never be verified in any 
particular case, because it is impossible to say if the pus has 
been absorbed, excepting in those cases where it forms buboes ; 
and every time that we remain uncertain as to the reality of 
the virulent absorption, it is impossible to affirm that a consti- 
tutional syphilis will be manifested, if mercury has not been 
given : for among those patients who have not taken mercury, 
we see few who are attacked with constitutional symptoms, 
consecutive upon a gonorrhoea. However it may be, it is pru- 
dent to prescribe a mercurial treatment ; for it can be admitted 
with reason, that we shall often thus prevent the establishment 
of a constitutional syphilis, as takes place when we administer 
it to patients affected with chancres or buboes, which under 
this treatment would certainly determine a general infection, 
sperience has taught us." — (Complete TVorks.) 

1 ask pardon for this long citation ; you know that it is not 
my custom ; but it appeared to me so much more necessary, 
as this doctrine serves still as the basis for the reasonings and 
the practice of a great number of writers upon syphilis. 

Must I first insist upon the manner in which Hunter admits 
the constitutional infection from blennorrhagia? It is not the 
part actually diseased that infects, it is the pus secreted ! Evi- 
dently Hunter has never reflected upon this singular mode of 
infection, and those who have followed him do not appear to 
have reflected any more. 

It is true that this doctrine has been singularlv revised and 
augmented. Thus, you will find in a modern writer upon 
syphilis, that in blennorrhagia. the infection does not take place 
by means of that portion of the mucous sur: ch is dis- 

eased, but through the portion of the mucous surface of th* 
rt which has remained healthy, this alone having 
the power to absorb the virulent muco-pus : from whence it is 
necessary, my friend, to draw this absurd conclusion, that if 

220 Ricord's Letters on Syphilis. L April, 

the entire length of the urethra was diseased, the consecutive 
infection would never be feared. 

The coques muqueuses of Hufeland are also an emanation 
from the Hunterian doctrine. You know that he pretends that 
if the blennorrhagia does not oftener infect, it is because the 
pus is enveloped in some small mucous follicles {coques), from 
which it has not always the power to escape. 

Let us return to Hunter, and be painfully surprised to see 
this great mind wishing to prevent infection by mercurial 
treatment, assuring us that the longer the disease has lasted, 
the more chances there will be of infection, and the more it 
will be necessary to give mercury : and not perceiving that if 
the mercury only acts by preventing the infection, its admin- 
istration would be useless after a long continuance of the blen- 
norrhagia, inasmuch as the infection would be already established 
and the mercury would have no power upon it. Be astonished 
that in spite of his uncertainty upon the action of mercury 
against the infection, he affirms in a manner so absolute its 
efficacy in doses so rigorously and mathematically determined! 
Be confounded, at not meeting in the passage cited but a tissue 
of wrong constructions and of contradictions. The mercurial 
treatment the most ordinarily excites blennorrhagic discharges, 
and Hunter wishes that it should be continued until the com- 
plete cessation of all secretion! How many patients, whose 
discharge does not stop, would be thus condemned to mercury 
forever ! My colleague, of whom I lately spoke to you, would 
have been literally choked with mercury. What w r ould have 
become, under the weight of a treatment so prolonged, of an 
old soldier whom I attended, who contracted blennorrhagia at 
the peace of Amiens, and who had it still in 1845 — that is to 
say, for more than forty years ? 

This entire doctrine of Hunter is lamentable from its discrep- 
ancies. Shall I afford myself the pleasure of demonstrating 
this singular confession — " The success of this practice can 
never be verified" ; and that one, more singular still — "We 
see few patients who are attacked with constitutional symp- 
toms consecutive upon a gonorrhoea." Is not every question, 
dear friend, even from the confession of Hunter, reduced to this 
— that the mercury is useful only in the small number of those 
patients, whose blennorrhagia is due to a urethral chancre ! 

Thus everything, even error, comes to confirm the exactitude 
and the truth of the doctrine of the Hospital du Midi. 

Lastly, the treatment of blennorrhagia brings us again into 
the presence of the theory of the half-way treatment of M. 
Lagneau, who regards blennorrhagia as a light form' of syphilis, 
and advises against it a demi-treatment. We see peep out 

1853.] RicorcTs Letters on Syphilis, 221 

here the demi- virus, and the demi-\ itulence, of our brother at 
Lyons, M. Baumes. 

Demi-treatment I Light form of syphilis I Alas! there is 
unfortunately nothing light as regards the verole, unless it be 
the certain opinions of very grave men. Syphilis exists, or it 
does not exist. \( there is syphilis, a treatment as complete as 
possible is necessary ; we must make use of all the guarantees 
that a serious and methodical treatment can give. Ii the verole 
dues not exist — good heaven, for what good is an anti-syphilitic 
treatment 1 How must we treat simple benign blennorrhagia ? 
I repeat again, that I confine myself to the generalities of the 
question. First, one word upon the abortive treatment. You 
know all that has been said upon repercussion, upon the theory 
of the wolf shut up in the sheep-fold ; you are aware of all the 
apprehensions which have been manifested in regard to the 
metastasis and the wandering about of the virus in the econo- 
my, occasioned by the abortive treatment of blennorrhagia. 
This doctrine has always astonisned me in presence of the 
facts which present themselves in crowds, and that, too, every 
day in practice. 

First, it is incontestable that the greater part of the accidents 
to which blennorrhagia can irive rise, never manifest them- 
selves before the end of the first week ; and it is from the se- 
cond week, and most generally later, that we see these accidents 
take place. 

On the other hand (and those who frequent the Hospital du 
Midi well know it), the greatest nun\ber of these accidents 
manifest themselves only in those cases of blennorrhagia where 
no treatment or an insignificant one has been made. Do you 
wish me to give you a singular proof of this? Here let me 
inform you incidentally that I profess a great deference for 
medical statistics, that preci(Jus instrument, which managed as 
it has been by the skilful hands of M. Louis, has rendered such 
incontestable services to our science. But M. Louis is the first 
to recognize and to proclaim that nothing is more difficult and 
more delicate than medical statistics; nothing which by its 
faults, or by its vicious application, could conduct to greater 
deceptions or to more deplorable errors. This profession of 
faith being made, I hope that no one can consider as an attack 
against statistics, or as a mockery of that precious instrument 
of research, what I am going to say relative to the causes of the 
accidents produced by blennorrhagia. 

I said that the abortive treatment of blennorrhagia was very 
innocent of the accidents which may be manifested in the 
course of this disease. Do you know, in truth, what the statis- 
tics absurdly interpreted would teach in this respect ? Why 

222 Ricord's Letters on Syphilis. [April, 

that the most frequent antecedent of epididymitis is flax-seed 
tea. I possess upon this point enormous statistics, and the stu- 
dents of my clinique wait every day with an hilarious impa- 
tience, this final question, which I never fail to address to the 
patient affected with an epididymitis — have you taken flax-seed 
tea ? The answer is inevitably affirmative. 

What shall we conclude from these statistics and facts ? 
Evidently that epididymitis, like the other accidents of blen- 
norrhagia, is neither a repercussion nor a metastasis, nor any of 
those chimera by which some have desired to oppose the time- 
ly and abortive treatment of blennorrhagia. 

I am profoundly convinced by my observation and by my 
long experience, that a blennorrhagia arrested the first days of 
its appearance, far from being followed by those accidents 
which are feared, will prevent, on the contrary, the manifesta- 
tion of them. The abortive treatment of blennorrhagia is at 
the same time the prophylactic treatment of the consecutive 
accidents. Thus, in my practice, I have adopted the abortive 
treatment applied at the first moments of the appearance of the 
blennorrhagia. This is a point of doctrine upon which I 
cannot too much insist — the commencement of the disease is 
known, its end and its consequences are always uncertain. It 
is, then, of great importance for the patient to disembarrass 
himself of his discharge as soon as possible. In spite of an old 
prejudice of which the practice of Bell could be the pretext, I 
profess, that the injections which constitute one of the most 
important parts of the abortive treatment, far from producing 
strictures of the- urethra, as has been said and still repeated, 
form the best abortive treatment for these strictures. We can 
be assured that the quicker a discharge shall be arrested., the 
less shall we have to fear the organized alterations of the ure- 
thra ; these latter are, as for alF other mucous surfaces, the 
consequence of the duration of the inflammation. I well know 
that here, again, statistics have been invoked, and that cases 
sufficiently numerous have been brought forward, in which 
strictures have manifested themselves after injections. But 
this is a little like the flax-seed tea in the cases of epididymitis. 
From this fact only, that injections are found among the ante- 
cedents of stricture, we must not infer a relation of cause to 

Analyze well these observations and you will see that it is a 
question of long-standing cases of blennorrhagia which have 
resisted every thing — even injections ; it is precisely because 
these injections have not cured the inflammation, that the stric- 
ture has followed — which fact does not necessarily imply their 
unskilful or untimely employment. 

1855.] Scrofulous and Rheumatic Inflammation. 891 

I do not wish to terminate this letter, my clear friend, without 
saying a word upon the prize which my honorable colleague 
ami friend, ML Diday, of Lyons, has just established. S ou 
kn«w that he offers the sum of 300 francs to whoever shall 
bring to him (en observations upon simple blennorrhagia which 
shall have produced constitutional syphilis. This idea is good, 
but do you think it sufficiently generous? Thirty francs for 
each observation so ditficult to find — frankly, is it enough ? I 
consider as beyond price one single fact of syphilis coming on 
without syphilitic cause ; thus I shall not establish any price 
upon this point. Let my wise and spiritual friend permit me 
to say to him, that he would neither compromise his present nor 
his future fortune, in increasing a hundred fold the value of the 
observations which he demands. — [Boston Medical and Sur- 
gical Journal. 

On Scrofulous and Rheumatic Inflammation of Joints. By 
Edward Stanley, Esq., F. R. S., Surgeon to St. Bartholo- 
mew's Hospital. 

[Mr. Stanley remarks upon the difference in the frequency 
with which certain joints are attacked by disease, and how 
exempt others seem to be from the like affections. An exam- 
ple of the former fact may be taken in the hip and knee-joints, 
and of the latter in the lower jaw, the sterno-clavicular articu- 
lation, or the heads of the ribs with the vertebrae. Some 
explain this by their greater or less exposure to external influ- 
ences ; but this cannot be the case, else why should the hip be 
more frequently attacked than the ankle-joint ? Others say 
that joints are more susceptible from the activity of their 
functions; but few joints are more exercised than the lower 
jaw, and vet few are more free from disease. After a few ob- 
servations on some cases of anchylosis of the lower jaw he 
proceeds :] 

I now come to the consideration of strumous inflammation of 
joints, and before proceeding to investigate its phenomena, the 
following questions demand attention : — 1st. What are the cir- 
cumstances which would lead us to regard the disease as 
strumous, when brought to the bedside of a patient? 2nd. In 
what condition should we expect to find the structures, viz., 
the bones, cartilages, and synovial membranes of a joint, pro- 
vided the be strumous? With reference to the first 
Question, 1 am unacquainted with any local symptom, any 
precise condition in the affected joint itself, which would ena- 
ble us at once to decide on its strumous nature. We must look 

224 Scrofulous and Rheumatic Inflammation. [April, 

elsewhere. The age and aspect of the patient, the past or 
present existence of scrofulous disease in other parts, such 
as enlargement and suppuration of the cervical absorbent 
glands, strumous ophthalmia, tubercle in the lungs and otfcer 
organs, — any of these, especially if actually co-existent, would 
justify us in regarding the disease as scrofulous. Often, indeed, 
these cases are obscure, and sometimes we are led to a wrong 
conclusion. The aspect of the patient is delusive, and should 
not be too much relied upon. Many instances occur in which 
the patient's appearance seems indicative of the existence of 
scrofula, whose subsequent progress and favourable recovery 
prove that such evidence is fallacious. 

We have now to answer the second question. What is the 
state of a joint invaded by strumous disease? The morbid 
specimen I now exhibit shows the condition of the articular 
extremity of a bone in an extreme attack of this nature. The 
end of the bone is softened from absorption of its earthy matter, 
and its cancelli are filled with tuberculous deposit. It is, how- 
ever, according to my experience, rare to meet with so com- 
plete an example of strumous disease as this specimen furnishes. 
In the majority of cases, I believe that no tubercular matter is 
found deposited, and when found, it is only in the last stages of 
the affection. Such a condition of bone, when it does exist, is, 
in my opinion, irreparable ; and, when the surgeon is summon- 
ed to a case exemplifying the disease in this its latest stage, he 
can do nothing to restore the bone to its natural state, nothing 
to accomplish a cure. There is, however, an earlier stage in 
these affections, which you will often have to treat in private, 
although it is seldom seen in hospital practice — a stage amena- 
ble to treatment, a stage in which, generally speaking, the mor- 
bid impairment of the bone may be arrested, and its integrity 
restored. It is characterized by increased heat, and enlarge- 
ment of the bone, immediately above the joint. There is, indeed, 
increased vascularity, and low inflammation of the bone, which 
is quickly followed by expansion of the cancellous texture, and 
absorption of earthy matter. Ultimately in bone thus degener- 
ated, tubercle is sometimes deposited. Such, then, is the state 
of the bone in a joint affected with struma. The other struc- 
tures, — the cartilages, synovial membrane, &c, are in a state 
of low inflammation, inflammation which has commenced either 
in the bone or the synovial membrane itself, and which, if suf- 
fered to advance, is followed by its usual consequences, — 
exudation, thickening of tissues, and sometimes suppuration. 
Now the appropriate treatment for an attack of this sort is, per- 
fect rest for the limb, and removal of all weight and pressure 
from the inflamed joint, so as to insure, as far as possible, its 

1853.] Scrofulous and Rheumatic Inflammation. 225 

complete tranquillity. If Inflammation exists in any activity. 

the judicious application of leeches will be beneficial; but it 
should be borne in mind that leeches must not be lavishly em- 
ployed, as strumous patients cannot stand depletion. The 
remainder of the treatment is constitutional, and should be 
directed to the restoration of the general health, if that has fail- 
ed ; to its maintenance if it has not. To this end country air, 
or, where it is practicable, a resort to the sea side should be 
recommended ; a light, nutritious diet enjoined, and the state of 
the stomach and bowels be carefully attended to. The follow- 
ing particulars of a case which occurred to me some years ago, 
illustrates forcibly the truth of my observation, that the articu- 
lar ends of bones rarely become the seats of tubercular deposi- 
tion, even in well-marked examples of strumous disease. 

A boy, ten years old, was under my care for scrofulous 
enlargement and suppuration of the cervical glands. While in 
the hospital, hip disease supervened, evidently of strumous char- 
acter, which ultimately wore out the patient. Examination of 
the body showed that the joint was disorganized ; the soft tis- 
sues around were infiltrated with tubercular deposit; the cap- 
sule and articular cartilages partially destroyed by ulceration; 
the bone was dislocated on the dorsum ilii ; the acetabulum 
widened, and containing tubercular matter. The mesenteric 
and other absorbent glands were infiltrated with tubercle. 
Tubercular ulceration was present in the intestinal canal. How- 
ever, when a longitudinal section of the head of the femur had 
been made, no tubercular deposit was found in the interior of 
the bone. Absorption of earthy matter, and widening of the 
cancelli, had taken place, but no interstitial tubercle existed. 

Not infrequently disease in the soft tissues around a joint, 
inflammation, and abscess, are mistaken for disease inside the 
joint : and. in some instances, eminent surgeons have amputa- 
ted limbs under the impression that an irremediable articular 
affection existed, while, in reality, the exterior tissues alone 
were involved, the joint itself being sound. 

Joints are liable to another form of inflammation, differing 
from that we have just reviewed, — "rheumatic inflammation.'' 
Examples of this disease occur generally in combination with 
rheumatic fever, and are. therefore, more prevalent in the medi- 
cal than in the surgical wards of the hospital. The diagnosis 
of articular rheumatism is not usually difficult. When rheu- 
matic fever is present, it is, of course, obvious; but when it is 
not. the implication of other joints, the cnuse and symptoms of 
the attack, and the history of prior rheumatism, will generally 
guide us to a right decision : the implication of other joints, 
because it is extremely rare to find rheumatism affecting one 

226 Scrofulous and Rheumatic Inflammation. [April, 

joint only; it attacks two or three simultaneously, or flies about 
from one to another : the cause and symptoms of the attack, — 
because we shall almost invariably find that the patient has 
been exposed to cold, or dampness, and because muscular pains 
are generally precursory to the articular inflammation. Rheu- 
matic disease thus induced, is commonly marked by pain in 
one particular spot; the patient does not complain of general 
pain in the joint, but points to one especial locality, and de- 
scribes it as the seat of all his suffering. 

Articular rheumatism is, moreover, intractable, leaving one 
joint and assailing another, or departing and recurring in the 
same joint. Joints are attacked by rheumatic inflammation in 
two ways; either their fibrous structures, their ligaments, suf- 
fer, or their sinovial membranes. Now the consequences of 
rheumatic inflammation of the ligaments may be serious, such, 
indeed, as may terminate in dislocation of the bones of a joint. 
For, under its influence, the ligaments become soft and elonga- 
ted, so as to permit the bone to slip out of the cavity in which 
it is naturally fixed. In this way the head of the femur may be 
displaced upwards on the dorsum i 11 i without rupture or ulcer- 
ation of either the capsula or the ligamentum terres. An ex- 
ample of such an occurrence happened some years ago in the 
practice of Mr. Lloyd. 

A painter, in the enjoyment of good average health, was in 
the habit each morning of taking a warm bath. After having 
done so on one occasion, he experienced a pain in the hip-joint; 
one of the joints of the fingers also became swollen and infla- 
med. He consulted a medical man, who gave him hopes of 
speedy recovery. Nevertheless, he remained in bed five 
weeks, after which, the pain having subsided, he was told to 
get up : this he found himself totally unable to do, and, on ex- 
amination, the limb was found to be shortened and inverted, 
the head of the bone having been dislocated on the dorsum illi. 

A case has also been related to me by Dr. Latham, in which 
articular rheumatism of long continuance produced dislocation. 
Some years ago, a young woman was in the hospital, under the 
care of Mr. Lawrence, suffering from rheumatism in the hip 
and wrist joints. She was confined for some time to her bed, 
and when permitted at length to get up found that she was 
lame, and that the lameness grew gradually worse. After a 
while she experienced a sensation as if the bone slipped from 
the socket when she walked. On examination, the limb was 
found of natural length, and its movements complete ; rotation, 
however, was remarkably free ; and when the thigh had been 
flexed on the pelvis, and was then rotated, the head of the bone 
could be evidently felt to pass over the brim of the acetabulum, 

1853.] Scrofulous and Rheumatic Inflammation. 227 

Cases like these illustrate the unusual results of a very com- 
mon affection, which, although often obstinate and tenacious of 

existence, generally terminates well, leaving an unimpaired 
joint behind. 

Rheumatic synovitis commonly ends in effusion. Ulceration 
of the articular cartilages may, however, supervene ; and I have 
witnessed a case in which this condition was set up within nine 
weeks from the commencement of the attack, so that it was 
found necessary to amputate the limb. More usually, however, 
rheumatic synovitis gives rise to anchylosis, such anchylosis as 
may result from the adhesion of opposite synovial surfaces by 
effusion of fibrin, and which, as I have explained in an early 
part of the lecture, is called spurious, in contradistinction to 
true or osseous anchylosis. 

Gonorrheal rheumatism is a form of the disease occurring 
in conjunction with gonorrhoea, brought on by exposure to the 
vicissitudes of weather, and to the development of which, a 
certain unhealthy constitutional state appears necessary. Un- 
like ordinary rheumatism, it confines itself to one or two joints, 
and unshiftincr, clings to them with remarkable tenacitv. It is, 
in truth, an affection that has long bafiled the powers of medi- 
cal surgery. In many instances the patients appear to recover, 
but the complaint returns on the slightest exposure, and no per- 
manent cure is effected. There is now under my care, in 
Lazarus, a Pole suffering from gonorrhceal rheumatism of the 
wrist joint. In him the disease has yielded for the present to 
three grain doses of the iodide of potassium, given three times 
daily; and I am informed that the gonorrhceal discharge, which 
had become scanty, has reappeared since the mitigation of the 
articular disease. The best possible termination in these cases, 
— a termination which has ensued in the instance I have men- 
tioned, is serous effusion into the joint ; for when the fluid is 
absorbed, it is not unlikely a useful joint may remain. Some- 
time back, a young man, aged twenty-one, was my patient in 
the hospital, in consequence of a most acute attack of rheuma- 
tism in the shoulder-joint, following gonorrhoea. Though he 
was in a reduced state, I ordered him to be bled from the arm ; 
mercury was administered ; in fact, very active treatment 
adopted. Serous effusion in the joint resulted, and with- 
in five weeks I had the gratification of seeing him leave the 
ital with the functions of the joint in a great measure re- 

We occasionally meet with examples of rheumatic synovitis 
occurring after parturition, which may originate anchylosis. 
The affection differs in no shape from ordinary rheumatic syno- 
vitis ; but it requires gentle treatment, as the patients attacked 

228 Pressure in Chronic Enlargement of Bones. [April, 

by it are generally much debilitated, and frequently suffering 
from some uterine complication. — [Medical Times and Gazette, 
Braithwaite^s Retrospect. 

Simple mode of applying Pressure in Chronic Enlargement 
of certain Bones, 6fC. — [Dr. Inman, of Liverpool, records 
the following case : 

M. C, a delicate girl, three years of age, had a swelling of the 
left knee-joint, which was three-quarters of an inch larger than 
the right, due to an enlargement of the head of the tibia and 
condyles of the femur.] 

Considering this to be a case more likely to be benefited by 
■steady pressure than by more severe remedies, I had recourse, 
at first, to strapping ; but finding this of no use I directed the 
mother to procure a piece of thin vulcanized India-rubber cloth, 
which she was to shape to the knee, allowing an interval in 
front of about three-quarters of an inch. The edges were to 
be bound by a piece of thin leather, and a piece of wash leather 
was to be placed as a tongue between the laced portion and 
the knee. Holes were to be made in the cloth behind the bind- 
ing, and the whole was to be laced like ladies' stays. The 
elastic was to be worn during the day and night. Exercise 
was not prohibited, and no medicine was ordered. I saw her 
again in ten days. The bandage had been worn for fourteen 
hours daily, and taken off at night. The knee was reduced a 
quarter of an inch in circumference. 

In ten days she called again, complaing of pain and oedema 
of the leg, in the. evening, from pressure. On removing the 
elastic, whose edges now overlapped, I found the knee restored 
to its normal size and shape. The child could run about with- 
out pain or inconvenience. I directed the disuse of the band- 
age, unless the swelling should return; and told the mother, 
that, though I could not promise that there would be no return 
of the complaint, I considered the child as cured. 

It is unnecessary to make any long comments upon this case. 
The fact of a morbid deposit in bone being absorbed, or, I might 
almost say, a threatened white-swelling, cured in three weeks, 
without blisters, issues, or caustics, without confinement, or 
even complete rest, is sufficient to speak for itself. Of course, 
such a plan can only be adopted when there is no reason to 
believe that active inflammation or purulent deposits are pre- 
sent, and where there is no severe pain. 

The only novelty in the idea is, probably, the kind of elastic 
adopted, which is superior to the elastic web, both on account 
of its cheapness and its smoothness. — [Ibid, 


1853.] Dislocations of the Hip-join! . 

A \ • \i , , Dislocations of the Hin-joi 

Pulleys or other mechanical means. By W. W. Reio, MA)., 
of Rochester, N. 5f. 

On the 13th mber, 1849, Dr. Moore, having a subject 

in process of dissection by bis students, proposed to me, that we 

•t up the muscles of the hip-joints, leaving them in situ : 
dislocate the bones and then operate on them by traction in the 
usual way, and also by flexion, alter my method, in order that 
we might observe the condition and action of the muscles, be- 
fore and during both modes of operation. 

We found it impossible to force the head of the bone through 
the capsular ligament, till we had made a slight incision into it. 
The bead then shot through it, tearing it sufficiently to permit 
its passage, but the ligament seemed to fit close around the neck 
of the bone. As the head passed out, backwards and upwards, 
it caught the tendon of the pyrifbrmis, tearing it off as it passed 
underneath and above it, which it' it had remained entire, v 
have brought its tendon like a cord across the neck, below and 
close to the head, lashing it closely down to the dorsum of the 
ilium. We were at the time inclined to attribute its rupture 
rather to the decayed state of the subject than to excessive dis- 
tention by the dislocation. But precisely the same thing oc- 
curred in di>! the other hip, although we endeavored 
to avoid it by pushing the bone in a different direction, but 
as the insertion of this muscle is at the root of the trochan- 
ter, it is evident it must obey its movements, and therefore 
preserve nearly the same relation to it and the head of the 
bone ; whatever direction it takes in being dislocated back- 
wards, that is, whether a little more obliquely downwards or 

When dislocated, the head of the femur rested on the gluteus 
minimum muscle ! The gluteus medius and maximus, psoas 
.us. illiacus interims, adductor, triceps and pectineus, were 
shortened and relaxed. Posteriorly, the obturator internus, 
gemelii and quadratus were greatly strained, and it was appa- 
rent that the piriformis, if it had not been torn off, would have 
been more stretched than they. Anteriorly, the obsturator 
externus was stretched, seemingly to its utm- ; fully 

adducting the bone, and thus preventing abduction and rota- 

Alter carefully noting the relative position of the bone and 

muscles, we made traction on the femur downward and inward 

the sound limb, as we are directed by most authors; but 

the moment the attempt was made the muscles already named 

as being in a state of tension, became more tense, and bound 

N. S. VOL. IX. XO. IV. 15 

230 Dislocations of the Hip-joint. L April, 

the head of the bone more firmly down on the dorsum; although 
all the muscles about the joint were separated from each other, 
were loose, without vitality, and almost in a state of decompo- 
sition; yet it was with great difficulty that we could bring 
down the head into its socket ; and when we did so, we carried 
away a part of the capsular ligament ; and if the pyriformis 
had not been torn off already, it seemed impossible that it 
should escape rupture now. But when we abducted, flexed, 
and carried the limb over the pelvis, as has been described, the 
reduction was effected with great ease. We repeated and va- 
ried our experiments on both joints, as often as the subject 
would admit, and always with the same results. I was here 
enabled to correct one error which I had committed in opera- 
ting. If we carried the knee above the umbillicus and pressed 
the thigh close to the body, on a line with the side, the pointing 
towards the axilla, as I have always done, we brought the 
great tendon of the gluteus maximus into strong tension, which 
would compress the trochanter so hard that it prevented 
the head from mounting over the edge of the acetabulum. 
The reduction was effected much easier by carrying the 
knee as high as the umbilicus, then abducting and rotating 
the thigh. 

From the foregoing facts and observations, I think we may 
justly deduce the following propositions : 

1st. The chief impediment in the reduction of recent dislo- 
cations, is the indirect action of muscles that are put upon the 
stretch by the mal-position of the dislocated bone, and not by 
the contraction of the muscles that are shortened. 

2nd. That muscles are capable of so little extension beyond 
their normal length, without hazard of rupture, that no attempt 
should be made to stretch them any farther, in order to reduce 
a dislocation, if that can possibly be avoided. 

3rd. The general rule for reducing dislocations should be, 
that the limb or bone should be removed, flexed, or drawn in 
that direction which will relax the distended muscles, and not 
by extension and counter-extension, for the simple purpose of 
overcoming the supposed contraction of muscles. 

4th. Dislocation of the femur on the dorsum iili, an accident 
heretofore esteemed so serious to the patient, and so formida- 
ble to all surgeons, is reduced with the greatest ease in a few 
seconds or minutes, without much pain, without an assistant, 
without pulleys, without Jarvis's adjuster, or any other me- 
chanical means, simply by flexing the leg on the thigh, car- 
rying the thigh over the sound one upward over the pelvis, 
as high as the umbilicus, and then by abducting and rota- 
ting it. — [Transylvania Medical Journal 

1853.] Observations on Diseases of the Ear. 231 

Practical Obs s on Diseases of the Ear, with records 

of Cases. By W. R. Wildb, £sq. 

Condyloma of the external meatus. — M. D. L., a female, 25, 
a seamstress, Buffering from deafness, tinnitus, occasional pain, 
fetid and sometimes bloody discharge from left ear for eight 
months; is otherwise healthy: attributes her affection to cold. 
The external meatus is completely closed by several condylo- 
mata which grow around its margin 1 , but particularly from its 
lower edge. They are rather sensitive to the touch, lobulated 
on their surface, project a considerable distance beyond the 
margin of the aperture, and are a little more florid in colour 
than the natural skin. When the tragus is pressed backwards 
with the finger, a muco-purulent and offensive discharge ex- 
udes between these growths. It is not possible to insert even 
a small-sized speculum into the meatus without causing great 
pain and irritation. She could only hear the watch on touch- 
ing. The right ear was normal. They were touched with the 
solid nitrate of silver, after which a poultice was applied. The 
subsequent treatment consisted in washing over the morbid 
growths with a strong solution of nitrate of silver every second 
or third day, and in the intermediate time, keeping a dossil of 
fine lint, wet with diluted liquor plumbi, applied to the concha, 
besides the internal administration of Plummers pill and sarsa- 
parilla. By persisting in this treatment for upwards of two 
months, the condylomata disappeared, leaving the meatus na- 
tural, when the membrana tympani was found unimpaired, and 
the hearii restored. 

I have seen a case of cutaneous cancerous ulceration, extend- 

om beneath the zygoma, which had quite eaten away the 
tragus, completely occluding the external meatus; but the most 
common causes of the diseases are eczematous and herpetic 
eruptions, and chronic erysipelas, as detailed in the two subse- 
quent cases. 

Eczema Aurium, thickening and closure of meatus audilorius 
externus. — M. Q., female, 00, has been deaf, "off and on/' for 
several years past, accompanied by noise and wandering pains 
in the head, with extreme itchiness in the auditory passages. 
The skin covering the auricle, and the scalp adjacent thereto, 

I fiery red colour, speckled with patches of yellow, form- 
ed by the exudation which has collected in thin branny scales 
all over it. The parts are hot, and in some places sticky, from 
a thin ichorous matter which exudes from the surface. The 
auricle has lost its natural shape, its folds and sinuosities being 

illy obliterated, and it has become hard, thickened and 
lumpy. The external auditory aperture has, owing to the dis- 

232 Observations on Diseases of the Ear. [April, 

ease extending into it, been lessened to a third of its natural 
size, and it is filled with a branny scurf. Upon removing the 
latter impediment, we can obtain but a very partial view of the 
membrana tympani, which appears to be thickened and opaque. 
Hearing distance, touching. The state of the parts is nearly 
the same on both sides. 

In examining diseases of the external meatus and auditory 
tube, I find a small silver instrument, shaped like a blunt gorget, 
very useful. 

Cases of this description, and, like this, of long standing, are 
very hard to manage, because there generally co-exists some 
constitutional taint, as shown in the cutaneous eruptions often 
manifest in other portions of the skin, and because the parts 
now under consideration have become so much altered in form 
and texture that it requires a long course of treatment to re- 
store them to their natural condition, and thereby re-establish 
their usual functions. The disease principally occurs in fe- 
males in middle and advanced life ; but it also happens to chil- 
dren from six to twelve years of age. In the latter, however, 
it is of a much more active nature, at the same time that it is 
much more amenable to treatment. In young persons the 
eruption often co-exists with scald head, and in both young and 
old, if the disease is allowed to exist for any length of time, it 
extends into the meatus, and even over the surface of the tym- 
panal membrane, which it thickens and renders opaque. In 
old persons a collection of branny scales accumulates in the 
external tube. In young persons a thick creamy discharge 
will generally be seen coating over the lining of the tube and 
the external layer of the membrana tympani. 

Cleanliness and attention are indispensable to the eradication 
of these affections. In the first instance, continual poulticing 
with any emollient substance which keeps up heat and moist- 
ure is necessary. Linseed meal, boiled bread and milk, or 
well-mashed turnips will be found useful applications. After- 
wards when the extreme heat, swelling, vesication, and redness 
have subsided, a solution of the liquor plumbi, in the proportion 
of a drachm to the ounce, applied with several bits of fine lint, 
so as completely to envelope the auricle, and the evaporation 
prevented by covering over the whole with a piece of oiled 
skin or thin gutta percha, rarely fails to lessen the irritation 
and reduce the parts to a healthy condition. But while we 
employ these local measures, we must not neglect constitution- 
al means. Strict attention to diet should be enforced ; salt 
meats, savoury dishes, and pastry ought to be avoided, and a 
sufficient quantity of fresh vegetables should be consumed at 
dinner. After the patient has been well purged, a course of 

1853.] Observations on Diseases of the Ear. 233 

Plummer's pill may be prescribed with advantage — at least five 
grains daily for an adult : and, in a little time, some of the pre- 
parations ofsarsapariUa administered in lime water will hasten 
the cure, and assist to eradicate the disease from the system. 
This affection is very apt to relapse, and we should therefore 
continue both our local and constitutional remedies long after 
the inflammatory symptoms have subsided. Old ladies think 
they never can have a suflicient amount of warmth about their 
head, and it is very difficult to induce them to leave oft' even 
one flannel nightcap ; but we should at least make the attempt, 
as the head and ear ought to be kept as cool as possible. As 
the swelling and inflammatory symptoms subside, we should 
again turn our attention to the state of the auditory tube. If 
any discharge exists, the meatus should be syringed gently with 
tepid water daily ; and both it, the concha, and the tympanal 
membrane, washed over every second or third day with a so- 
lution of nitrate of silver of the strength of at least twelve 
grains to the. ounce. Still more advanced in the progress of 
this treatment when the exudation has completely ceased and 
the thickened cuticle has been quite removed, much benefit will 
be derived from smearing over the tube and membrana tym- 
pani with brown citrine ointment every third or fourth day. 
This latter remedy, of which I have great faith in all diseases 
similar to that which we are now considering, should be made 
with either rape or cod-liver oil instead of the lard or butter 
usually directed in the Pharmacopoeias. It is then of a much 
darker colour, and never becomes hard or crumbly. It should 
be applied in a melted state with a camel's-hair pencil, and dilu- 
ted by about one-third of almond oil. 

Chronic erysipelas of auricle. — T. M., female, 52, has had 
frequent attacks of erysipelas of the head and face during the 
last five or six years. The effects of the disease are, however, 
now manifest only in the external ears, but more particularly 
the right. The auricle is not much enlarged, but has become 
hard, inflexible, and resembles a piece of wet thick sole leather ; 
its fossae being apparently filled up by subcutaneous deposit. 
It is also somewhat shortened in its antero-posterior diameter. 
The skin is of a dusky brown colour without any exudation, 
eruptions, or crusts upon it, but to the feel it is lumpy and 
nodulated, like what we find in certain forms of elephantiasis. 
The lobe in particular presents this thickened appearance. 
The cfiseai [tended some way in front of the site of th? 

tragus, which is also thickened and lumpy. The meatus is 
nearly closed. The treatment of this disease is very similar to 
that of the forego 

Dr. Kramer relates cases of scirrhous degeneration of the 

234 Observations on Diseases of the Ear. [April, 

auricle, but it would appear that he has applied the term to 
cases similar to that now under consideration. 

Enlargement of the sebaceous follicles in the concha fre- 
quently present in pale, cachectic persons labouring under aural 
diseases. They are easily recognized by their dark heads, and 
can be pressed out with a pair of forceps. Besides these ecze- 
matous eruptions which I described in one case, many other 
cutaneous diseases affect the auricle, particularly in children. 
You are all aware of the excoriations which take place in in- 
fants behind the ears during dentition, and of the popular belief 
that they are salutary. Cleanliness is their chief cure when it 
is advisable to heal them up. We have a disease in Ireland so 
prevalent in some countries, that it would appear to be one of 
our national maladies — pemphigus gangrenosis, first described 
by the late Dr. Whitley Stokes, and of which I have given a 
description in the medical memoir attached to the Census of 
1841. So fatal is this disease among children that no less than 
17,799 deaths have been attributed to it in ten years ; and as it 
is a disease very well known to the lower orders, I am inclined 
to think that the amount has not been exaggerated. It goes 
under different local names, but the most common are " morti- 
fying hive," "burnt hole," and " black ear ;" the latter from its 
so frequently appearing behind the ears and upon the auricles. 
In the Irish it is styled ithcheadh, or the eating disorder, from 
its phagedaenic character. The vesicles, or bulla? peculiar to 
this affection, generally leave an indelible irregular lace-like 
depression, similar to that of vaccination. 

Anomalous tumour in the external meatus. — M. N., female, 
aged 47, has been deaf of the right ear for many years, and is 
much annoyed by itching and a stuffed feeling in the meatus. 
Upon inspection we find a tumour in shape, size and colour, re- 
sembling a half-ripe mulberry, occupying the anterior and 
lower edge of the meatus, and extending some way into the 
auditory tube, which it almost completely blocks up. It is not 
unlike that disease known here as button scurvy, and to which 
the late Dr. Wallace, of this city, gave the name of morula. 
It is attached by its broad base throughout its whole extent, 
and has neither enlarged nor extended for the last three years, 
during which time I have been in the habit of examining it 
occasionally. The patient never had otorrhcea, and there is no 
discharge now present, but occasionally the tumour becomes 
painful and irritable, and its colour deepens from a florid red to 
a purple. It is now of a firm consistence, corrugated on its 
surface, and has a firm unyielding feel, quite unlike a naevus, 
for which at first sight it might be mistaken. I will not meddle 
with this tumour at present, as I once saw an affection very 

1853.] Glycerine in certain forms of DeafneM. 285 

similar ill appearance in a lady about this woman's timeoflife 
end in frightful cancer, apparently from an endeavour to re- 
move it by escharotics. 

We meet with various other growths in the externa] meatus 
and auditory tube, independent of polypus or Other morbid pro- 
duets, resulting from inflammation or its consequences. One 
of the most frequent of these is exostosis, of which I have seen 
very many examples. The projection generally grows from 
the posterior edge of the osseous portion of the tube, and slow- 
ly, but gradually projects forwards, so as to leave but a slight 
crescent-shaped fissure between it and the anterior wall of the 
meatus. The integuments covering such growths are general- 
ly very smooth, white, and polished. I have never seen this 
disease affect both ears, but I have often remarked it in con- 
nexion with inflammatory ailections both of the external tube 
and the membrana tympani. Autenrieth has given an account 
of one of these growths, and lately Mr. Toynbee communica- 
ted a valuable paper on the subject to the ' Provincial Medical 
and Surgical Journal.' We had lately at the hospital a young 
woman in whom the external meatus was closed by a dense 
membrane, through which, when an incision was made, a probe 
introduced into the wound came in contact with the bone. As 
the patient had never heard on that side, and had never suffer- 
ed from any aural disease in infancy, as well as from the cir- 
cumstance of there being no bony meatus, we must consider 
that case as one of congenital defect, of which there are several 
similar examples on record. I have on two occasions, in pri- 
vate practice, seen a structure of the auditory tube at the junc- 
tion of the membrano-cartilaginous and osseous portions, in one 
instance so small as only to admit the round extremity of an 
ordinary dressing probe. Hardened cerumen having accumu- 
lated behind it, it was with great difficulty removed. — [Medical 
Times and Gazette. 

The Use of Glycerine in err lain forms of Deafness. By 
David Steel, M. D., of Petersburg, Va. 

Having read with some interest in the London Lancet an 
account of the use of glycerine in some of the most common 
forms of deafness. I feel it my duty, for the benefit of those who 
do not get the Lancet, to lay before them the result of my ex- 
perience with this agent in some few cases that have come 
under my treatment. 

July 17th, 1852. M 55, of scrofulous hibit, com- 

plains of deafness, with a constant rumbling noise in both ears. 
He stated that he has been in this situation for the last two 

236 Glycerine in certain forms of Deafness. [April, 

years ; thinks it proceeded from a severe cold taken about that 
time. Present condition: natural secretion wanting; aural 
canal dry and shining; membrana tympani slightly ulcerated 
in one. Ordered them to be well cleansed with warm water, 
which brought away some small lumps of hardened cerumen. 
Afterwards applied, by means of a fine camel-hair pencil, a 
sol. of argt. nit. grs. x, aq. distill §j, to the ulcer, and at the 
same time counter-irritation behind both ears by means of the 
ungt. cantharidin. After healing the ulcers, I directed the 
patient to take a small piece of cotton or wool, well saturated 
with glycerine, twisted into a small roll, and inserted into both 
ears as far as the membrana tympani. This to be continued 
night and morning, cleansing them well previous to its applica- 
tion. Patient being of a scrofulous habit, directed the follow- 
ing: fy. Hydrg. bi-chlor. gr. j ; antim. et potass tart. grs. ij ; 
ext. sarsaparilla 3ss. M. Ft. Pil. mass dividend xx. One 
sum. ter die. 

July 27th. Patjent discharged, well. 

July 29th. R , aged : his mother stated that he could 

not hear her, unless spoken to in a very loud tone of voice, and 
that there was a continual watery discharge from both ears, 
which, to use her own expression, "soils his clothes so much 
that I cannot keep him clean." In this case the membrana 
tympani in both ears were slightly ulcerated. All these symp- 
toms supervened upon an attack of measles six months previ- 
ous. Ordered, as in first case, ears to be well cleansed with 
warm water, and applied a solution of argt. nit. grs. v ; aq. 
distill 3 j. After the ulcer healed, directed glycerine, as in the 
preceding case. 

Aug. 25th. Patient discharged, well. 

Aug. 11th. T , aged 23, stated that about four months 

previous he had an attack of erysipelas in his head, which, by 
suitable treatment, was soon conquered, but left him in his pre- 
sent condition, viz., deafness in both ears, a constant, loud, 
rumbling noise, and a thin watery discharge from each, which, 
he says, "is very disagreeable." No ulceration of the mem- 
brana tympani ; directed ears to be cleansed with warm water, 
and the glycerine applied as in the preceding cases. 

Sept. 1st. Patient discharged, well. 

Aug. 19th. D , aged 29, a native of New York, stated 

that when in that city he had an attack of acute inflammation 
of the internal and external ear, which, by appropriate remedies, 
w 7 as soon relieved of the heat, pain, swelling, &c, but left him 
with deafness and a disagreeable crackling noise in one ear. 
Directed same treatment as in case No. 3. 

Sept. 15th. Patient discharged, well. 

1853.] Stricture of (Esophagus. 237 

Remarks. — From an examination of the preceding cases, it 
will be seen that glycerine was the principal remedial agent 
used. Its use in these cases was determined on from reading 
a paper of Mr. Wakly, surgeon to the Royal Free Hospital, 
editor of the London Lancet, &c, and I can fully appreciate 
the high wrought eulogy bestowed upon it by that eminent 
surgeon. I have copied the above cases from my note-book to 
show the pathological conditions in which it is applicable, be- 
cause it is not applicable in all cases ; for in complete deafness, 
caused by paralysis of the auditory nerve, by displacement of 
the small bones of the ear or any other structural lesion, or 
where other senses are deficient besides those of audition, this 
agent offers but little hope of success ; but in all cases where 
the natural secretion is wanting, the auditory canal dry, shining 
and inelastic — where sonorous undulations have been obstruct- 
ed by hardened secretion — or where there is reason to believe 
a chronic inflammation of the mucous passages of the internal 
structure existed — this agent may in a majority of cases be 
used with success. 

The preceding cases are not picked, but detailed as they pre- 
sented themselves. Many more could be brought, (and many 
more are under treatment, the result of which I am unable to 
say,) to show the high value of this agent in the treatment of 
most of the common forms of deafness ; but I trust I have ad- 
duced a sufficient number to bring the attention of the profes- 
sion to a closer examination of this article, which, when done, 
I shall have accomplished the object for which this paper is 
intended. — [Stethoscope. 

Case of Stricture of (Esophagus. By William Johnson, M.D. 

I was consulted, the 23d of last July, by M C , aged 

about 22 years, on account of stricture of the oesophagus. Her 
attention was called to it, about two years since. She was 
eating a piece af pickled cucumber, and was choked, and still 
more so very shortly afterwards, in eating a pear. Since then, 
the disease has been gradually increasing. Early in her dis- 
ease, she could swallow nothing but liquid articles, or solid 
food very thoroughly masticated, and swallowed in very mi- 
nute portions at a time. In fact, for some considerable time 
back, she has avoided taking any solid food ; particularly ani- 
mal, it chokes her even when well masticated, and swallowed 
in minute portions — liquid food sometimes does the same. She 
became very much alarmed, in consequence of the arrest of a 
very small cherry stone in her oesophagus, about the 30th of 

238 Stricture of (Esophagus. [April, 

June last. She was eating a cherry, and the stone accident- 
ally slipped into the oesophagus, and produced the greatest 
distress by being arrested there. She resides about two miles 
from me. In my absence, my son speedily saw her. He di- 
rected a solution of tartarized antimony to be held in her mouth ; 
it produced great nausea, and in an effort to vomit the stone 
was ejected. This patient is anaemic, probably from insufficient 
nutrition. Her appetite for food is good, but she is unable to 
take sufficient nourishment. The catamenia are regular. Oc- 
cular inspection of the fauces elicited nothing abnormal. 

As tentative measures, I put her for a short time on tinct. 
ferri. chlor., iodid. pctas., and applied an epispastic to the throat. 
The difficulty of deglutition was not in any degree relieved by 
these means. I now resorted to the bougie. My bougies were 
prepared, by saturating strips of muslin in melted bees wax, 
and when cold, cutting those pieces in such shape, as when 
rolled up tight they would be gently tapering. They were 
made of various sizes, from f of an inch to 1J of an inch in 
circumference. I commenced, by introducing the smaller 
sized, and found difficulty in passing these, but the difficulty 
rapidly gave way, and in a few weeks I passed the larger 
sized with ease. The size that I used for the greatest length 
of time, was If inches in circumference. I finally passed very 
readily If of an inch in circumference. 

The stricture, I found to be situated some inches below the 
termination of the pharynx. I passed the bougie some inches 
below the stricture, which did not appear to occupy a very 
large extent of surface. A sense of resistance at the stricture 
in passing the instrument through it, was experienced. After 
passing it a few times, most decided relief was obtained by the 
patient. She visited my office, nearly every alternate day, for 
three months, and the bougie was introduced at every visit, 
either by myself, or my son. 

The sense of suffocation, produced by the presence of the 
bougie in the oesophagus, was very distressing to the patient, 
and she could bear it but a short time at each introduction. I 
generally passed it twice or three times every visit which she 
paid me, which was much facilitated by covering it well with 

In using the instrument, I departed from the directions given 
by Velpeau. He advises depressing the tongue with a spoon- 
handle or other instrument. This I did not find necessary, and 
he says nothing about throwing the patient's head far back, 
which I found very important. My method of introducing the 
instrument was, to have the patient supported by an assistant 
standing behind her. The assistant was directed to bring the 

1853.] Veratrum Viride. 239 

patient's head far back, so as to render the passage from the 
mouth into the throat as straight as possible, the instrument 
would then, by a very slight curve in it, readily pass down into 
the oesophagus. Its introduction was rendered easier by the 
patient protruding her tongue (which she could do with ease) 
from her mouth. The patient experienced no pain from the 
operation ; nothing but the strangulation above spoken of. 

The improvement in this case, was decided, from almost the 
first introduction of the bougie, until I pronounced her cured. 
I suggested, however, at parting with her, that it would be ad- 
visable to have the instrument passed occasionally into the oeso- 
phagus, but she found herself so completely relieved that she 
did not return, and I learn that she remains well, and has mar- 
ried since. Her mother stated, but two or three days since, 
that she swallows her food with perfect ease; the bougie has 
not been introduced since October last — nearly four months. 
Remarks. — The chief point of interest in this case is, the 
rapidity with which it yielded to treatment. The case I would 
contrast with one related by Dr. Jameson, of Baltimore, in the 
29th No. vol. viii., of the Medical Recorder, Jan. 1825; edited 
by Samuel Calhoun, M. D., of Philadelphia. The Doctor's 
case is a very interesting one, and will pay well for the perusal. 
Dr. Jameson passed ivory balls of different sizes, attached to a 
stem, upon which they were secured, nearly every day for ten 
months, before he considered his patient cured. My patient 
was cured by the bougie passed every alternate day for three 
months. Whether this result was owing to the different kinds 
of instruments employed, or in my case being a less serious 
one, I do not pretend to decide. Dr. Jameson's patient, too, 
was a female, but more advanced in life than mine ; his being 
about 40 years of age, and his case, too, was of two years 
standing. For more than a fortnight he did not succeed in 
obtaining any advantages : but by indomitable perseverance, 
obtained complete success. His patient was one year under 
treatment. These two cases, in addition to others, give ground 
for encouragement in persevering attempts to dilate strictures, 
and it may yet be found, that well directed manipulation may 
obviate the necessity for resorting to the caustic, in the man- 
agement of these cases. — [New Jersey Medical Reporter. 

Veratrum Viride. 

Dr. B. T. Kneeland, an intelligent physician of Livingston 
county writes us in regard to the use of veratrum viride — ''I am 
in the habit of using veratrum to quiet the action of the heart, 
in diseases attended with great arterial excitement, where it is 

240 Circulatory Displacement. [April, 

more fashionable to employ digitalis, and with far more cer- 
tainty of effect than I could ever obtain with the latter remedy. 
I have thus used veratrum in rheumatism, pneumonia, the early 
stages of fever, &c. I first tried it in a severe case of pneumo- 
nia, the patient having already passed into a comatose state 
from what I considered defective arterialization of the blood, 
and with applications of cold to the head, and warmth to the 
feet, had the satisfaction of seeing a return of consciousness 
within twelve hours, and his recovery under the continuance 
of the same treatment. In a case of acute rheumatism, after 
employing the wine of colchicum, and various other remedies, 
without any apparent benefit, the pulse still continuing at 120, 
full and hard, I gave three grains of the powdered root of vera- 
trum viride, which acted powerfully upon the circulation, 
causing temporary blindness, and reducing the frequency of the 
pulse to 85 per minute. He was now put upon lemon juice, 
and had a rapid and most satisfactory convalescence. 

"I recollect to have read in one of the last numbers of the 
N. Y. Journal, a plan of treating continued fever, by giving 
tartar emetic until free vomiting is induced, and then relying 
upon large doses of quinine. Now I have ventured a step be- 
yond this, and commenced the treatment of those cases which 
began with the usual symptoms of fever, with veratrum and 
have obtained the most gratifying results. It has seemed to 
procure periodicity r , and thus prepare the case for the success- 
ful administration of quinine. With this treatment I have had 
no case last over five days, contrary to my former belief, that 
typhus fever must run until the morbid poison is eliminated. 
When the usual treatment is pursued the majority of cases 
prove fatal in this vicinity, and those which recover have a 
long and tedious course." — [New York Journ. of Med. 

Circulatory Displacement. By H. B. Orr, of Nashville, Tenn. 

The process for extracting the active principle of medical 
drugs by circulatory displacement has until recently been re- 
garded more as a speculation or theory than as a practical fact. 
Several years since it was spoken of by Mr. Alsop, of London, 
as convenient in making infusions; subsequently Dr. Benton 
suggested the idea of applying it in tincturing, and more recent- 
ly Professor Procter has written in its commendation. But 
yet the intrinsic merits of the method have not received from 
pharmaceutists that measure of regard which they seem to de- 

My attention was drawn to this method of maceration by an 
article recently communicated to the American Journal of 

1853.] Circulatory Displacement. 241 

Pharmacy by Mr. Laidly, of Richmond. Virginia. I was 
pleased with the suggestions induced by the perusal of Mr. 
L.'s paper, and was constrained to try the method in a variety 
of cases, and thus confirm, what indeed seemed to be at once 
obvious, its practicability: my expectations were entirely re- 
alized, and it is this that prompts me to commend its investiga- 
tion to pharmaceutists. 

This mode of tincturation is"very simple and convenient in 
its construction. The best form of apparatus is a cylindrical 
vessel with a movable diaphragm and a closely fitting top. The 
liquid having been put into the vessel, the diaphragm with the 
substance on it is then introduced so that a thin stratum of the 
menstruum supernates above it. The whole adjustment is then 
made and no further attention is required. 

This kind of apparatus is very well substituted by a bottle 
with a large mouth, the size of the bottle depending upon the 
bulk of the ingredients, observing to keep always as much depth 
of liquid beneath the drug as practicable, and then a bag as 
great in diameter and as shallow as possible completes the 

It will be observed that this form of maceration is in all the 
important points different and directly opposed to the old me- 
thod ; they are opposite in principle also. In the old mode the 
drug is put at the bottom of the vessel — in the new it is kept at 
the top of the menstruum; in the former you arrive at an ap- 
proximate saturation by shaking the mixture — in the latter 
saturation is obtained by the natural precipitation which goes 
on constantly : the one demands attention throughout, the other 
needs no w 7 atching; the old process is retarded by gravity, the 
new is facilitated by this principle, for gravity is the promoting 
cause of the circulation — it is really the sine qua non of the 
process. Immediately upon the adjustment of the apparatus, 
this principle is seen in active operation, by the colored solu- 
tion descending in the vessel, (in consequence of the condensa- 
tion in the union of the soluble substance with the menstruum,) 
affording ocular evidence that the solution is progressing. It 
is then a physical certainty that this mode is applicable, and we 
are forced to conclude that it is the only scientific mode of tinc- 

There is another feature in the process which will prove an 
additional convenience and abridgment in many cases, and 
which, so far as I am informed, has as yet been unnoticed. It 
is that of enveloping the substance in filtering paper before 
introducing it into the bag. By this arrangement the time and 
trouble of subsequent filtration is dispensed with. And this 
obviates an evil of some importance in itself; for with men- 

242 Chloride of Zinc Paste in Fistula in Ano. [April, 

strua of a volatile nature, the time requisite fur their filtration 
affords opportunity for considerable evaporation, and in pro- 
portion to this evaporation the bulk of the solution is diminish- 
ed, giving to it an uncalled for density, this being a condition 
without any provision and of evil tendency. But by effecting 
the filtration during the process of solution, it not only aids the 
pharmaceutist, but is of advantage with respect to the quality 
of his product. 

The circulatory method is thought to be more rapid in its 
operation, generally, than the usual mode ; in many cases it 
certainly is decidedly so, as an instance of which guaiacum may 
be adduced, as in the preparation of ammoniated tincture of 
guaiacum. Here at the commencement of the process the 
colored saturated liquid may be seen to emerge from out of the 
bag and then to commence its meandering descent, with a 
waving motion, mirroring a variety of colors, giving to the 
operation a most beautiful appearance. This descent of the 
solution and the corresponding ascent of the less dense or un- 
saturated particles of the menstruum, have conferred the ap- 
pelation of "circulatory " upon the process. The solution of 
gums, resins and sugar also affords instances of the facility of 
this method. 

In point of strength, the result must show favorably for it, 
for at each moment the most active portion of the menstruum 
is in contact with the substance, so that the depletion must be 
thorough as well as the action rapid. And I cannot but reit- 
erate the expression of Mr. Laidley ; I hope pharmaceutists 
will more generally avail themselves of so simple and easy 
mode of extracting the active principle of medical drugs. 

[Southern Journ. Med. and Ph. Sciences. 

Chloride of Zinc Paste in Fistula in Ano. By E. Lacy, Esq. 

[Mr. Lacy recommends the application of chloride of zinc 
paste in fistula, on account of the perfect success resulting from 
it in three cases. It is applied as follows :] 

The ordinary paste (chloride of zinc, water, and flour), being 
entangled in a grooved probe, is passed up to the opening in the 
rectum. The point of a second probe or instrument is then 
placed in the grove, and passed just sufficiently high up, that, 
by its being retained in that position while the armed probe is 
withdrawn, the groove may be cleansed of the paste. This 
may be repeated every second or third day. — [Medical Times 
and Gazette. Braithwaites Ret. 

1853.] Cause of Decay of the Teeth in Cki Id r en. 243 

On the cause of Decay in the Teeth of Children. 

"What is the nature of that diathesis or constitutional predisposition or dis- 
order (if any) which so often occasion decay in the teeth of our children V — 
Dr. Drake to the Miss. Vol. Association, D. S. 

[We meet the following remarks upon this interesting subject 
in a small pamphlet entitled "A letter to Daniel Drake, M.D., 
on the cause of premature decay in the deciduous teeth, in 
which is embodied a review of the discussion of the Mississippi 
Valley Association of Dental Surgeons upon the same subject." 
Having examined, individually and collectively, the conclu- 
sions arrived at by this society, the writer says :] 

"I now come to the second object of this letter, that of at- 
tempting an answer to your first question, which, according to 
my understanding of the subject, the ' Mississippi Valley Asso- 
ciation of Dental Surgeons' have utterly failed to give. In 
making this effort I shall be very brief. I shall content myself 
by simply stating facts, without entering into any minute de- 

The strict interpretation of your question embraces an en- 
quiry into all kinds of decay to which the deciduous teeth are 
liable. Now as there are two prominent causes of this kind of 
decay in the temporary teeth — causes which differ from each 
other both in their nature and the time of life at which they 
commence — it is important, therefore, that they should be here 
referred to. The one is almost identical with the prevailing 
cause of caries in the permanent teeth, and usually commences 
its ravages in the molars, and that about the fifth or sixth year 
of the child's age. The other may be said to be sui-generis. 
It shows itself most frequently in the incisors, and is liable to 
commence at any period, from the time the teeth first show 
themselves through the gums, up to that when dentition is fully 
completed. Believing that your inquiries were intended only 
to embrace the last mentioned cause of disease in the decidu- 
ous teeth, I shall therefore confine my answer solely to a de- 
scription of this cause ; deferring all further notice of the other 
until I come to reply to your second question respecting the 
premature decay of the permanent teeth. 

The 'diathesis, or constitutional predisposition, or disorder, 
which so often occasions decay in the teeth of our children,' is 
remotely constitutional in its nature, and appears to partake 
both of a scrofulous and of an acquired vice: of a scrofulous 
vice, because it is most prone to attack the teeth of scrofulous 
subjects: of an acquired vice, because the general system must 
be likewise much impaired for a shorter or longer period be- 
fore the immediate cause of the caries of the teeth is induced* 

244 Cause of Decay of the Teeth in Children. [April, 

The immediate cause of the decay is a malignant ulcer, most 
generally peculiar to the gums, but occasionally attacking the 

The ulcer is most liable to occur at three particular epochs 
of a child's life, and appears to increase in malignancy with 
the child's increase of years. 

The first period, and most common and mildest form of the 
disease, occurs during the cutting of the incisor teeth. It some- 
times commences with the first appearance of these teeth — 
sometimes not until they have all acquired their full length 
through the gums. 

The ulcer is generally confined to the extreme edge of the 
gums, revealing only a small, light, ash-colored, sigzag line, so 
small that it is rarely detected by either physician or nurse. 
Upon a close examination, the edge of the gum will be found 
separated from the teeth, and the body of the ulcer plainly seen 
betw r een the edge of the gum and the necks of the teeth. 

The gum reveals but little signs of inflammation, is not very 
sensitive, and may remain in the condition just described seve- 
ral weeks without any material increase or diminution of the 

The teeth become slightly loose, rough and dark colored, and 
are finally more or less destroyed, depending on the virulency 
and duration of the ulcer. It is this form of the disease that 
occasions so many children to have dark colored, decayed, and 
broken off incisors, from the age of one year and upwards, 
while the molars may be sometimes entirely sound. This 
form of the disease has never, before, so far as I know, been 

The second period that the disease occurs, but much less 
rarely than the first, is about the time of cutting the molar teeth, 
and is sometimes very malignant. The ulcer usually appears 
on the gum at a point where a tooth is about to penetrate, and 
proceeds to a greater or less extent, often around the entire 
dental arch. The disease may appear in its mildest form, and 
run only along the extreme edge of the gums, or it may involve 
the greater portion of both the ^um and alveolar process, loosen- 
ing the teeth, turning them dark and softening them, as though 
they had been exposed to the strongest acids. This form of 
the disease has been occasionally observed and described. 

The third form of the disease is fortunately still more rare, 
but fearfully fatal. It usually appears during the shedding of 
the temporary teeth, and although always commencing on the 
gum, it rapidly extends to the cheek, often destroying both jaw 
and cheek, as well as the life of the patient. This form of the 
disease has been described by medical writers under the name 
of cancrum oris. 

1853.] Hospital Sulphate of Quinine. 245 

All three of the forms of the ulcer just described are liable, 
and have often been mistaken, for the effects of mercury. But 
the sharp, ragged, yet well defined edge of the ulcer — the ex- 
coriating and corroding effects of the discharge — the slight 
tumefaction of the gums, and the terrible fetor of the breath, 
even in its mildest form — a fetor having nothing of the odor of 
that arising from mercurial salivation — are characteristics suf- 
ficiently marked to say nothing of the roughness and discolora- 
tion of the teeth, to prevent any mistake of that kind, if closely 
observed." — [South. Journ. Med. and Phys. Sciences. 

Hospital Sulphate of Quinine. 

Mr. Edward Herring has introduced a preparation under 
this name, consisting of disulphate of quinine only partially 
purified. In its medicinal properties it is said to differ but little 
from the ordinary disulphate. It has a brownish color, and is, 
of course not admissible as a substitute for disulphate of quinine 
in general dispensing, but it has been tried in hospitals and dis- 
pensaries, and by some medical men who dispense their own 
medicines. The preparation is recommended on account of 
its economy. The final purification and decolorization of the 
salt being attended with some expense, the manufacturer is en- 
abled to offer it in a partially purified state at a considerable 
reduction from the price at which it can be sold when purified 
in the usual way. The amount of impurity must be ascertain- 
ed before its real value can be estimated. It may be a question 
whether the recognition of a preparation so imperfectly purifi- 
ed might not open the door to some abuse. — [London Pharm, 

On Disguising the Taste of Quinine. By M. Piorry. 

A piece of chocolate should be half masticated, and retained 
between the cheeks and the teeth. The quinine draught is to 
be rapidly swallowed; and then the masticatiou of the choco- 
late is to be completed, so that it may be swallowed also. The 
taste of the quinine is thus hardly perceived. — [Bull, de V Acade- 
mic Med. Chir. Rev. 

Vesicating Oil. By E. Dupuy. 

The solubility of cantharadin in chloroform, as shown by the 
experiments of Professor W. Procter, suggested to me the idea of 
using that vehicle in combination with a fixed oil to obtain a vesi- 
cating agent, freed from the disagreeable concomitants of the ordina- 

N. 3. VOL. IX. NO. IV. 16 

246 New Remedy for Intermittent Fever. [April, 

ry fly blister, and retaining the cantharadin in a soluble state. I 
proceed thus : 

Powdered cantharides, one part. 

Castor O'l ' ( °^ eacn (by weight) one and a half parts. 

To the powder was added the mixture of chloroform and oil in a 
close vessel; the ingredients were transferred, after some hours, to a 
glass apparatus, and the liquid displaced in the usual way. It amount- 
ed to about two-thirds of the original bulk of the liquid employed. A 
few drops of the vesicating oil applied to the arm of an adult produced 
a perfect blister in eight hours. Its easy application on any given 
surface may be of value as a vesicatory or epispastic. I w r ould sug- 
gest the use of oiled silk over the application of it to the skin ; by re- 
taining the moisture of the skin it will favor the action of the oil. 

[Amer. Journal of Pharmacy. 

A New Remedy for Intermittent Fever. 
Dr. Wm. M. Holton, of New York, in a note to the editor of the 
N. Y. Medical Gazette, proposes the "Prairie Dock" or ^'Partheni- 
um Integrifolium" as a remedy for Intermittent fever. 

" A decoction made by pouring hot water upon two ounces of the 
dried tops of the plant, has proved equal to twenty grains of quinine. 

I have entire confidence in it, not having met a single failure in 
over thirty cases, some of which were severe. 

I do not claim that it is superior to quinine, except that so far, no 
unpleasant nervous effects have been observed. 

I claim to be the first to call the attention of the profession to this 
remedy, and trust that farther trial and chemical analysis will confirm 
my belief in its efficacy, and enable me to give to the profession proof 
of the value of an article, the active principle of which, I have no 
doubt, will equal quinine, while the supply is abundant, and obtained 
in our own country." 

The readers of this Journal are acquainted with the views of 
Dr. Marshall Hall in regard to the pathology of Epilepsy, and its 
connection with what he denominates either Trachelismus or Laryn- 
gismus, according to the violence of the symptoms. They are also 
aware that he proposes Tracheotomy as a remedy for this formi- 
dable affection, and that this operation has actually been performed 
with temporary advantage. It seems questionable, however, whether 
the remedy is not as bad as the disease. Dr. Horace Green reports 
in the New- York Medical Gazette an interesting trial made of a less 

1853.] Epilepsy. 247 

objectionable method for modifying the innervation of the larynx in 
such cases. We subjoin an extract from Dr. G.'s report. 

u In reflecting on this patient's case, in connection with the theory 
advanced by Marshall Hall, I recollected the fact, that spasm of the 
glottis occurring in my practice, in laryngeal disease, had, in many 
instances, yielded to the topical applications of nitrate of silver to the 
larynx ; and at this interview, I proposed to Mr. B. to try the effects 
of cauterization of the larynx, before having recourse to tracheotomy. 
He consented, and with a sponge-probang I immediately applied a 
strong solution of the nitrate of silver to the interior of the larynx. 
At this first application of the remedy to the larynx, I remarked the 
unusual insensibility of the parts to the local irritant ; for, although 
the ordinary caution, that of cauterizing the pharynx and opening of 
the glottis before passing the probang into the larynx, was not adopted, 
yet not the slightest cough, or apparent irritation was induced, not- 
withstanding the sponge, charged with a strong solution of the salt, 
(45 grs. to the oz. of water.) was carried deep into the larynx. On 
the following day the patient returned, and the application was re- 
peated, and this was done daily for five or six consecutive days. It 
should be remembered that when this local treatment was commenced 
the patient was having some six or eight attacks of epileptic fits daily ; 
and that with the occasional exceptions, of which I have spoken, 
these attacks had occurred daily, during a period of four years. After 
the first application of the nitrate of silver to the larynx, the spasms 
ceased, and Mr. B. passed over a period often days without having a 
single epileptic attack. The change that took place in this period in 
his mental powers was as marked as that which occurred in the dis- 
eased nervous functions. His mind, before obscured, became clear, 
his memory improved, and he exhibited a spirit buoyant and happy 
when freed from the evil spirit that had so long possessed him. 

This intermission continued until the tenth day, when, after having 
been exposed to considerable excitement, in the transaction of some 
business, he had a slight epileptic attack. On the two or three fol- 
lowing days he had several attacks on each of these days. The treat- 
ment was again renewed, and after a few cauterizations of the larynx 
the spasms again ceased and the patient escaped through another 
period of ten days when the attacks came on as before. It was now 
apparent that the disease partook of that intermittent character which 
has been observed by Dr. Babbington and other writers on Epilepsy*. 

The attacks had occurred so constantly, through so long a period 
of years, that I could not learn that any thing like periodicity had 
been before observed as a characteristic of the disease in this case. 
This feature, however, was so apparent now, that I determined to try 
the effect of quinine, in order, if possible to break it up. 

Again were the applications of the nitrate renewed, and in order to 
produce as much effect as possible on the larynx, the strength of the 
solution was increased to eighty grains to the ounce of water, and 
sponge-probang, nearly straight, being used, ^the applications were 

248 Epilepsy. [April, 

carried through the larynx and trachea to the bronchial bifurca- 

As in each instance before, the spasms ceased after continuing the 
application a few days, and passing the critical period; but as the 
patient approached the termination of this second decade, he was di- 
rected to take ten grains of quinine daily, for several days. This 
was done, the applications were continued, and the patient passed over 
the critical period and on the nineteenth day, without experiencing the 
slightest attack. 

In this period of immunity from the disease — a longer period than 
had occurred in many years, Mr. B.'s spirits and general health 
improved constantly, and he occupied himself in his business (that of 
collector) almost daily, during this interval. But near the close of 
the nineteenth day, or about the commencement of the twentieth, his 
disease again returned, and the fits occurred as before for several 
successive days. There was no difficulty, however, in arresting the 
spasms by the topical treatment, as soon as this period was passed; 
and this has been the case up to the present time. That is, no diffi- 
culty occurs in arresting entirely the attacks of epilepsy, for a period 
of from ten to twenty days, during which interval the patient appears 
in excellent health, in good spirits, and in the possession of his ordina- 
ry mental powers. 

In three instances, since the commencement of this treatment has 
the patient been carried over the first decade, but in no instance, as 
yet, have we been able to get over the twentieth day, without a return 
of the disease. At this present time, January 27th, he is on one of 
his intermission periods, and he appears as exempt from all disease, 
and declares that he feels as well as he has felt at any time of his 

As the patient has in only one instance, as yet, employed freely the 
anti-periodic remedy, it has been determined to enter again on its use, 
with the hope that by its full administration the intermittent character 
of the disease may be controlled, and the patient restored to permanent 

Without endorsing all the views advanced by Marshall Hall, on the 
nature and treatment of some of the diseases of the nervous system, I 
am prepared to admit that the practical results in this case have alrea- 
dy been such as to warrant the conclusion that in epilepsy not origin- 
ating in organic lesion, a morbid condition of the larynx may consti- 
tute the essential connecting link between the primary exciting cause 
of the disease and the subsequent convulsions; and to warrant the 
hope that in recent cases of inorganic epilepsy, we have it in our 
power, by an entirely safe and facile mode of treatment, to break up 
this connection, and arrest the disease." 

* At the present day, Mr. Editor, I trust this assertion can be made without 
having one's veracity called in question, or endangering one's status in any me- 
dical society to which he may belong ! 

1853.] Miscellany. 249 

ill 1 c 1 1 1 a n g . 

The Pinto Indians. — We have often heard marvellous accounts 
of a singular race of spotted Indians called Pintos seen by our troops 
during the late war with Mexico. The following very interesting 
statement corroborates the opinion we had advanced with regard to 
the nature of the spots, in our unwillingness to admit the Pintos as a 
distinct race of men. 

Account of a peculiar class of Aboriginal Inhabitants of certain parts 

of Mexico, known under the name of the Pinto Indians. By Col. 

A. C. Ramsey, formerly of the United States Army. Communica- 
ted by Edward Ludlow, M. D., of this city. 

Interspersed among the native population of certain parts of Mexico, 
are to be found a class of Indians, in greater or less numbers, pre- 
senting characteristics so marked as at once to arrest the attention of 
the observer. To this peculiar appearance they owe the name by 
which they are familiarly known, that of " Pintos," or painted people, 
the word being an abbreviation of the Spanish word pintado, painted. 
It is impossible to convey by writing a correct idea of their appear- 
ance ; no two of them are alike either in color or in marks on their 
persons. You will see a pretty formed girl with one hand white and 
the other black ; her face spotted of a gray, blue, black, or white co- 
lor. Sometimes a man will have one half of his face lead color, and 
the other half of a copper complexion. 

Here you will see an arm partly white and partly black, as though 
you had " barked" it, and taken orTone portion of the outer skin. 

A foot or leg will be spotted black, blue, white, dec, while the other 
parts will be all of one color. 

Many appear with dark skin on the face, with a large black spot 
covering the nose and cheeks. 

I have often seen these people with the face all as blue as lead ; 
again all black or red ; while their bodies would be entirely of the 
natural Indian color. 

Nothing on this earth more visibly depicts despair, and extinguishes 
all emotion of human sympathy within you, than the sight of some of 
these miserable beings. Some created a feeling of horror ; but the 
larger portion of them are not revolting in their appearance, but only 
repulsive from their looks. They live for the most part in villages by 
themselves, speaking only the Aztec language, ignorant, poor, super- 
stitious, and without any hope or ambition. 

So little intercourse exists between the Pintos and the white people, 
that it is almost impossible to get any account of their origin, malady, 
or condition. I have heard various histories of them, some absurd 
enough, and some contradicted by well-authenticated facts ; but have 
never seen nor heard of any description of them in print. Some say 
that they are a race of outcasts, who, from some far-off country, were 
ejected from the parent stock, and spread themselves along the Pacific 

250 Miscellany. [April, 

from Sonora to Guatemala ; that their disease is not only hereditary 
but contagious, being of a syphilitic or venereal nature. Therefore, 
personal contact with a Pinto, to Cat with the same spoon, drink out 
of the same cup, sleep on the same bed, or even breathe the same air, 
has been said to produce the disease. 

Sanitary laws have prohibited their passing beyond their own ter- 

None are permitted to enter Mexico, nor are they seen even in Cu- 

In the valley of Puebla they are not found before reaching Cuetzala. 
In the late war with the United States, the regiments raised from 
among them were not allowed to defend the capital, or even to en- 
camp with the other soldiers. The dread entertained by the people of 
the cities, among all classes, for these unfortunate Pintosis laughable. 
It is rarely that a gentleman from the capital can be induced to 
make a journey to this part of the country. He lives in constant appre- 
hension of infection, and would die of fright if among them. Hence 
one of the reasons why this magnificent valley is so little known. 

It is said that white persons have sometimes been diseased by the 
Pintos ; and they will tell you instances in Mexico, how these unfor- 
tunate persons have been infected by the most trivial intercourse, 
while studiously avoiding all contact. Of course their statements 
are to be taken with the same grains of allowance that are given by 
medical men to the most astonishing revelations of gentlemen who 
sometimes consult them when peculiarly afflicted. 

It is not considered proper to speak to a Pinto on the subject of his 
disease or the cause of it. It is always good policy not to use the 
word in their presence, as it is a stigma of reproach. 

To ascertain, therefore, something of their history, I have made 
many inquiries of intelligent officials who are stationed in their villa- 
ges. But from the most part of these I could glean no information ; 
they knew nothing about them, and they did not seem to desire to 
know anything. From others I was more fortunate ; and although I 
may still be misinformed, yet there seems reason to believe that this 
strange affection originated in the last century in the following manner. 
The volcano of Inrullo was formed on the night of the 29th of Sept., 
in the year 1759. This eruption, in which the mountain rose from 
the plain, and by which a large extent of ground totally changed its 
character, is admitted by all to have been one of the most astonishing 
physical changes known in the history of the world. 

A large space of level country, in which sugar cane and indigo 
were cultivated, extended between the small streams of Cuitamba and 
San Pedro. This tract of land was known as the hacienda of San 
Pedro de Jorullo, and as one of the richest in Mexico. 

In the month of June, 1759, a subterraneous noise was heard: 
hollow and rumb'injr sounds, accompanied with many earthquakes, 
followed in succession for two months, to the great terror of the inhab- 
itants ; and on the 29th of September, the mountain rose from the 
plain to the height of 224 feet. The panic stricken natives fled to the 

1853,] Miscellany. 251 

mountains of Aguascara, to escape a terrestrial convulsion which ex- 
tended beyond six miles square. 

From this place of safety the flames were seen to burst forth on all 
sides for more than three square miles. Fragments of burning rocks 
were thrown up to a prodigious height. Clouds of ashes hung over, 
which were illuminated by the volcanic lire. The heated earth be- 
came liquid, and undulated like a tempest-tossed sea. 

The streams of Cuitamba and San Pedro flowed into the burning 
abyss, which seemed only to add to the brilliancy of the flames. For 
many months this volcano was in perpetual convulsion, but finally 

The natives fled forever from a spot which they believed to be 
cursed. But the exhalation of sulphur had affected them. 

A strange eruption appeared upon their skins, accompanied with an 
itching and smell, which were both painful and offensive. The whole 
appearance of the people thus diseased underwent a complete trans- 
formation. The skin changed color ; spots of every size, and on all 
parts of the body, began to assume a permanent hue. It was then 
discovered that the disease was infectious, and whole villages be- 
came contaminated. 

Whenever one of these people went abroad, his person presented 
such strange colored marks that others could not believe them natural, 
but supposed them produced by paint, and hence their appellation of 
pinto, or painted. 

The disease is only cutaneous, and is accompanied with eruption 
on the skin, and is easily cured by cleanliness and mercurial ointment. 
But as these people are too poor or too indifferent to resort to the well 
known remedy, or do not all use it in a village at the same time, the 
pest is not permanently eradicated, but returns to plague the whole 

That the Pinto malady is not hereditary has been well tested by 
many facts. Although a man or woman limpid, that is, free from the 
taint, marries a Pinto, and in the course of time becomes Pinio, and 
also becomes so from continuous personal contact, still the offspring 
exhibits no marks or symptoms of the disease till more than two years 
old. If a child born of a Pinto mother be nursed from its birth by a 
person limpia, instead of by its Pinto parent, it never is affected, unless 
from accidental causes, afterwards. On the contrary, a child born of 
parents Umpia, if nursed by persons Pinto, will, after the second year, 
show the usual appearances of infection. 

I have found persons of intelligence, gente de rason, living all their 
lives with their families among the Pinto people, and never dreadino- 
the affection for themselves or children. 

It is true their little ones are not permitted to sport with Pinto pla} r - 
mates, and in that respect they do not differ from careful mothers in 
other countries, who will not suffer their children to associate with 
dirty, and possibly diseased boys or girls. 

For my own part, I have been much among the Pintos. I have 
lodged in their houses ; I have slept on their thalme or cane beds ; I 

252 Miscellany. [April, 

have eaten of their cooking ; taken water from the tinaja, or family 
jar ; have drank the milk which their cows have given, and often 
using the same xicara, or calabash cup ; and, when I could not help 
it, I have swallowed tortillas, or corn cakes, which they have patted 
smooth and ;hin between their hands. In wading rivers I have clung 
with my arms around a Pinto, and have worn clothes washed and 
dried for me by Pinto women. By the margin of rivers or other 
streams, the Pinto marks are somewhat less perceptible and peculiar 
than in places more remote from water. The balseros, or men who 
are engaged in floating the calabash and cane rafts, and who are con- 
sequently everyday swimming, exhibit but few indications of this 
affection upon their persons. But as they grow older, and quit that 
occupation, they assume one of the thousand varieties of the disease. 
No doubt that strict personal cleanliness would do much to relieve 
these people ; and if the village priests would borrow 7 a stray leaf 
from the Koran under this head, I think the church would wink at the 

The Pintos may be said to inhabit a mountainous country, as they 
are rarely found on the plains or in rich settlements. Thus we only 
discovered them at Cuetzala, where the mountain district properly 
commences; and further down the river, when the mountains are 
passed, they diappeared. I have observed, on former excursions, 
that Pintos are not found near the rich cities and open country round 
Tepeacuacuilco and Iguala, only 14 leagues distant from this place.* 
Hence I would infer that it is only their poverty that keeps them in 
the Pinto state. 

It is to be hoped that further intercourse with these unfortunate 
beings will remove the dread and disgust entertained for them by the 
better classes of the Mexican republic. They are simple, kind, honest, 
hospitable, and industrious where there is any occasion to work. They 
are only troublesome when excited by liquor, insult, or wrongs. Their 
disease is a species of itch — nothing more. My advice to any one 
thrown among them would be to keep clean, and keep the ten com- 
mandments ; with a white shirt, cotton clothing, and a clear con- 
science, there need be no fear of contamination. — [IV. York Medical 

The best means to preserve Leeches healthy. By Gustavus Schul- 
ler. — The apothecaries in Moldavia are, according to the sanitary 
laws, compelled to keep constantly a stock of at least 300 healthy and 
serviceable leeches. But, particularly as the hot summer months are 
the most prejudicial season for these animals, it often happens that in 
the time of the greatest need no leeches are to be obtained. 

Amongst the various means which have been recommended to keep 

* This account was written at Totalzintla, a village or pueblo on the left bank 
of the river Mescala. One of the roads leading from Mexico to Acapulco, 
crosses the river at this Pinto village. At the lime it was written (last August), 
Col. R. was exploiing and surveying the river Mescala, which takes its rise 
above the city of Puebla, and empties into the Pacific ocean at Zucatula, some 
three hundred miles west of Acapulco.— [En. 

1853.] Miscellany. 253 

leeches healthy, and to restore the sick ones, good well-burnt wood 
charcoal has proved, according to my experience, to be the best, as 
shown by the following experiment. I washed the charcoal well three 
or four times with fresh spring water, to separate the adhering ashes, 
and then laid it, while wet, and without breaking it smaller, in a large 
glass cylinder ; put the sick leeches, recently washed, into this cylin- 
der, but did not give them any more water, as enough was to be found 
in the washed charcoal. The glass was tied over with a piece of 
linen and placed in a cellar, where, for five days, the leeches were 
resigned to their fate. 

After this period I found the leeches, to my satisfaction, perfectly 
well. They were quite in a condition to be used, which was not the 
case in their sick condition. 

For two years I have treated my leeches in this way, and always 
retained them healthy and serviceable. The number of deaths a- 
mongst them has been very small. The only precaution I observe is 
to place all my leeches for eight days in summer on recently washed 
charcoal, and for two weeks in winter. The method is a cheap one. 
and one easy of execution. — [Buckner's Rejpertorium, from Annals of 
Parm. Am. Journ. Pharm. 

Note on the Preparation of Liquid Glue. By M. S. Dumoulin. — 
All chemists are aware, that when a solution of glue (gelatine) is 
heated and cooled several times in contact with the air, it loses the 
property of forming a jelly. M. Gmelin observed, that a solution of 
isinglass, enclosed in a sealed glass tube and kept in a state of ebulli- 
tion on the water-bath for several days, presented the same phenome- 
non, that is to say, the glue remained fluid, and did not form a jelly. 

The change thus produced is one of the problems most difficult of 
solution in organic chemistry. It may be supposed, however, that in 
the alteration which the glue undergoes, the oxygen of the air or of 
the water plays a principle part ; what leads me to think this is the 
effect produced upon glue by a small quantity of nitric acid. It is 
well known, that by treating gelatine with an excess of this acid, it is 
converted by heat into malic and oxalic acids, fatty matter, tannin, 
&c. But it is not thus when this glue is treated with its weight of 
water and with a small quantity of nitric acid ; by this means a glue 
is obtained which preserves nearly all its primitive qualities, but 
which has no longer the power of forming a jelly. Upon this process, 
which I communicated, is founded the Parisian manufacture of the 
glue which is sold in France under the title of " colle liquide et inal- 

This glue being very convenient for cabinet-makers, joiners, paste- 
board workers, toy makers, and others, as it is applied cold, I think it 
my duty, in order to increase its manufacture, to publish the process. 

It consists in taking 1 kilogrm. [2 and l-5th lbs.] of glue, and dis- 
solving it in 1 litre [2 and l-9th pts.] of water in a glazed pot over a 
gentle fire, or what is better, in the water-bath, stirring it from time 
to time. When all the glue is melted, 200 grms. [7 oz. Av.] of nitric 

254 Miscellany. [April, 

acid (spec. grav. 1'32) are to be poured in, in small quantities at a 
time. This addition produces an effervescence, owing to the disen- 
gagement of hyponitrousacid. When all the acid is added, the vessel 
is to be taken from the fire, and left to cool. 

I have kept the glue, thus prepared, in an open vessel during more 
than two years, without its undergoing any change. It is very con- 
venient in chemical operations ; I use it with advantage in my labora- 
tory for the preservation of various gases, by covering strips of linen 
with it. — [Chemical Gazette, from Comples Rendus. Ibid. 

Sulphite Soda for Preserving Dead Bodies. — A prize of 2000 francs 
was awarded to M. Sucquet for his improved method of preserving 
bodies by the injection of an antiseptic liquid through the carotid 
arteries. This preservative liquid is prepared as follows : A current 
of sulphurous acid gas is passed through a solution of carbonate of 
soda of the strength of from 20° to 22° Baume (sp. gr. 1-160 to M80), 
until the whole ef the carbonic acid is displaced, and the solution 
contains a slight excess of sulphurous acid. The fluid should then 
have a specific gravity of 1*200. It is next placed in a vessel con- 
taining clippings of zinc, and allowed to remain in contact with the 
metal until it has become sensibly neutral, the blade of a'knife dipped 
into it not turning brown on exposure to the air. From four to six 
litres of this preparation are employed to inject a subject. After 
twenty. four hours, dissection may be proceeded with, and continued, 
without any inconvenience, for twenty, thirty, or even forty days. 
One of the great advantages arising from the employment of the 
sulphite of soda, consists in the beneficial influence it exerts in cases of 
the accidents to which the operator is subject in the dissecting room. 

During the five years in which this preservative liquid has been 
employed, no fatal case has occurred. — [N. O. Med. Register. 

Discovery of Anaesthesia. — We have received a commnnication 
from Dr. C. W. Long, of Athens, (formerly of Jackson county,) who 
takes exception to the remarks under the Editorial head of our last 
number, and reminds us of the priority of his discovery of anaesthesia, 
as published in this Journal in December, 1849. The reader will 
perceive, on referring to the editorial remarks in question, that they 
applied to "the relative merits of the three claimants" before Con- 
gress (Drs. Jackson, Morton and Wells), and that they were directly 
elicited by the Congressional documents on the subject just received 
by us. The circumstance that the claim for compensation has been 
urged with great zeal and pertinacity (and consequent publicity) be- 
fore Congress, by these gentlemen, for the last two or three sessions, 
without meeting with any opposition or counter claim at the hands of 
Dr. Long, was well calculated to lead one to infer that he had yielded 
the point, or relinquished his own rights. Moreover, as we were not 




the conductor of this Journal at the time Dr. L. published in it his 
article, the full force of that communication had escaped our memory. 
We regret the omission to allude, in our remarks, to Dr. L.'s publica- 
tion, for, on a reperusal of it now, we are free to acknowledge that 
the Doctor has very clearly established the fact that he did, in 1842, 
perform several painless surgical operations under the influence of 
the inhalation of sulphuric Ether, — and that he was thus early and 
subsequently seriously engaged in experimenting with this agent as 
an anaesthetic. We really think that Dr. Long has done himself 
great injustice in neglecting to bring his claims before Congress in 
competition with those of others. The Doctor's modesty and disin- 
terestedness have concurred to make him rest satisfied with his own 
consciousness of merit. We trust, however, that he will not longer 
remain thus quiet, but use every exertion to throw the weight of his 
claims into the scales by which Congressional compensation is to be 
awarded — and nothing would give us more real satisfaction than to 
see the honor of that great discovery fixed upon the brow of a citizen 
of our own native State. 

Medical College of Georgia. — The twenty-first Annual Commence, 
mentof this institution took place on the 1st day of March. The 
exercises were conducted at the Masonic Hall, in presence of a large 
concourse of citizens. The Dean reported to the Board of Trustees 
that there were in attendance upon the Course of Lectures just con- 
cluded, one hundred and seventy-one gentlemen — of whom 115 were 
from Georgia, 29 from Alabama, 21 from South Carolina, 2 from 
North Carolina, 1 from Tennessee, 1 from Mississippi, 1 from New 
York, and 1 from Canada. 

The Degree of Doctor of Medicine was then conferred upon the 
following fifty approved candidates: 


David Adams, 

- Thesis on 


W. J. Arrington, - 




A. F. Attaway, 



Spinal Irritation, 

James C. Carroll, 




John S. Clements, 



Veratrum Viride, 

R. J. Cochran, 




A. G. Couch, 



Typhoid Fever, 

L. S. Cunningham, 




L. W. Davis, 

m m it 


Puerperal Fever, 

W. H. Dean, 

m m M 


Uterine Hemorrhage 

L. C. Fambro, 



Veratrum Viride, 

W. T. Goldsmith, 








Thesis on Cynanche Trachealis. 

" " Mortification, 

" H Scarlatina, 

" u Typhoid Fever, 

" " Gonorrhoea, 

" " Dysentery, 

" " Lobelia, 

u " Dyspepsia, 

u u Dysentery, 

" " Measles, 

u « Fever, 

" " Infantile Remittents. 

u " Injuries of the Head. 

" " Fetal Circulation, 

" " Intermittent Fever, 

" " Typhoid Fever, 

" " Conception. 

" " Intermittent Fever. 

" " Abortion, 

it i( Pregnancy, 

" " Spinal Irritation. 

" u Abortion. 

" " Typhoid Fever, 

" " Retroversio Uteri. 




Fracture of Cranium. 


The Vascular System, 




Thesis on Bronchitis, 

" " Rheumatism, 

" M Pleurisy, 

" " Digestion, 

" " Dyspepsia, 


- Thesis on Empiricism. 

The Honorary Degree of Doctor of Medicine was also conferred 
upon Wra, J. Rusk, of Habersham County, and Joshua King, M.D., 
a graduate of Castleton Medical College, was admitted ad eundum 

The Address to the Graduates was delivered by Dr. W. C. Ware, 

V. T. Hart, 
J. L. Hamilton, 
Joseph Hatton, 
Henry Hicks, 

E. C. Hughes, - 
John R. Humphries, 
Loyd Knight, 
Johnson Matthews, 
L. S. Means, 
John P. K. McWhorter 
L. W. Mobley, - 

R. F. Neely, 

D. S. Perkins, - 

F. W. B. Perkins, 
Ormond Pinkerton, 
W. L. Rees, 
Aristides Reynolds, . 
L. J. Robert, 

John Scogin, 
B. D. Smith, 
J. T. Slaughter, 
J. W. Stephens, 
F. J. West, 
John S. Wilson, 

James C. Billingslea, 
John E. Crews, 
B. C. Flake, 
R. T. Foote, 
W. A. Johnson, 
Wilson M. Liggen, 
James Penn, 
S. E. Thompson, 

S. C. Brunson, 
W. W. Graham, 
J. A. K. Holman, 
G. W. A. McRea, 
J. W. West, - 

N. H. Wiggins, 



Thesis on 


1853.] Miscellany. 257 

of Abbeville District, S. C, one of tbe alumni of this college, and 
the Valedictory by W. J. Arrington, of the graduating class — both of 
which admirably chaste and appropriate productions have been re- 
quested by the Trustees for publication. 


A System of Practical Surgery. By Wm. Fergusson, F. R. S. ; 
Prof, of Surgery in King's College, London, &c, &c. 4th Amer- 
ican, from the 3d and enlarged London edition — with 393 illustra- 
tions. Philadelphia : Blanchard & Lea. 1853. 

Among the numerous works upon Surgery published of late years, 
we know of none we value more highly than the one before us. It 
is perhaps the very best we have for a text-book and for ordinary 
reference, being concise and eminently practical. 

Manual of Physiology. By W. S. Kirkes, M. D., &c, &c, assist, 
ed by Jas. Paget, F. R. S., &c, &c. 2d American, from the 2d 
London edition — with 165 illustrations. Philadelphia : Blanchard 
& Lea. 1853. 

The general favor with which the 1st edition of this work was re- 
ceived, and its adoption as a favorite text-book by many of our colleges 
will ensure a large circulation to this improved edition. It will fully 
meet the wants of the student. 

What to observe at the bed-side and after death in medical cases. — 
Published under the authority of the London Medical Society of 
observation. Philadelphia: Blanchard & Lea. 1853. 

This little work, if carefully read by even old practitioners, cannot 
fail to be productive of much good. As a guide to the younger mem- 
bers of the profession in directing their attention specially to the best 
mode of investigating cases so as to arrive at correct diagnosis, it will 
prove exceedingly valuable. The great difficulty with beginners 
who have not been under the immediate training of an experienced 
physician, is continually found to be in the appreciation of the true 
condition of the organs and tissues. Let such provide themselves 
with this work and study it thoroughly — and they will find much of 
the difficulty removed. 

Ranking 's Half-yearly Abstract of the Medical Sciences. — No. 16. 
A very good number of an excellent work — would be better if not 
so exclusively European. 

258 Miscellany. L A P r ^> 

A Clinical Phrase-look, in English and German. Containing the 
usual questions and answers employed in examining and prescrib- 
ing for patients, &c, &c. By Montgomery Johns, M. D. Phil- 
adelphia : Lindsay & Blakiston. 1853. 

This is a little book designed for the use of physicians who practice 
in districts and hospitals in which the number of newly arrived Ger- 
mans may render it necessary to be somewhat acquainted with their 

Maclise's Surgical Anatomy ; with additions from Bourgery, fyc. Ed- 
ited by R. W. Piper, M.D. Boston : Jno. J. Jewett & Co. Part 1. 

This work will be completed in 8 or 10 parts, of quarto size, at 
75 cents each — the first of which is before us. We like to see books 
made as cheap as possible, but unless the engravings appended to 
them for illustration be good, they serve rather to confuse than to en- 
lighten the student. In the present instance the plates are very poor. 

The American Journal of Science and Arts ; conducted by Professors 
B. Silliman, B. Silliman, Jr., and James B. Dana ; aided by 
Dr. Wolcott Gibbs, of New-York, in Physicks and Chemistry, 
and Prof. Asa Gray, of Cambridge, in Botany. Published at New 
Haven, Conn., every 2d month, at $5 per year. 

This is a peiiodical of which every American should be proud, and 
which ought to be taken by every lover of the natural sciences in our 
country — for it is as ably conducted as any similar work in the world, 
and it is the only repository of the contributions of our fellow citizens 
to the study of Nature and the Arts. The March No. contains 13 
original communications, among which are the admirable papers of 
Jas. D. Dana on "Changes of Level in the Pacific Ocean" — of A. 
Bigelow on the "Mounds of the Tensaw River" — of M. A. DeQua- 
trefages " on the Phosphorescence of some Marine Invertebrata— of 
J. D. Dana " on the question whether Temperature determines the 
Distribution of Marine species of Animals in Depth" — of J. L. Smith 
on the "Re-examination of American Minerals" — of W. Hopkins 
on " The causes which may have produced changes in the Earth's 
superficial Temperature," &c. In addition to the original articles, 
each No. contains a resume of scientific intelligence. 

We are also indebted to publishers and authors for the following 
works, which our space will not permit us to notice more fully at pre- 
sent : — The Transactions of the College of Physicians of Philadel- 
phia, Vol. 1, No. 9 — Report of the Pennsylvania Hospital for the In- 
sane, for 1852 — The Prize Essay of Prof. Flint, on Variations of Pitch 

1853.] Miscellany. 259 

in Percussion and Respiratory sound and their application to physical 
Diagnosis — Elephantiasis Arabum successfully treated by ligature of 
the femoral Artery, by Prof. Carnochan — Remarks on Osteo-aneurism 
by the same — New Views of Provisional callus, by F. H. Hamil- 
ton, M. D. — A Treatise on the causes, constitutional effects and treat- 
mentof Uterine Displacements, by W. E. Coale, M. D. — Smithson- 
ian Report on Recent Improvements in the Chemical Arts, by Prof. 
J. C. Booth and C. Morfit — Sixth Annual Report of the Regents of 
the Smithsonian Institute — First Report of the Surgeons of the New 
York Ophthalmic Hospital — Syllabus of a course of Lectures on Dis- 
eases of the Eye at the New York Ophthalmic Hospital, by M. Ste- 
phenson, M. D. — A Discourse on the life, character and services of 
Daniel Drake, M. D., by Prof. Gross — Introductory Addresses, by 
'Prof. Lawson of Cincinnati, Prof. Bowling of Nashville, Prof. 
Hughes of Iowa University — and sundry Reports and Documents on 
the subject of the Discovery of Anaesthetics. 

We cheerfully place the "Dublin Medical Press" upon our ex- 
change list, and hope that its accomplished Editor may be as well 
pleased with our efforts as we are with the specimen he has sent us. 
Dublin is now the seat of as much Professional ability as any city in 
the British Isles. 

Whitlow. — Somebody proposes as an abortive treatment of whitlow 
the application, very early, of mercurial ointment to the finger. We 
doubt its efficacy, but if any one will try it, we would like to know 
the result. 

A handsome present. — Messrs. Philip Schieffelin, Haines & Co., 
Druggists, of New York, have presented to the Medical College of 
Georgia a complete series of specimens of the Materia Medica, put 
up in large glass-stoppered bottles for exhibition to the Class. It is 
altogether one of the finest collections of the kind we have ever seen, 
and the specimens, being hermetically sealed, will long remain to 
attest the taste and liberality of the respected donors. 

Dr. Marshall Hall is on a visit to the United States. We hope that 
he may visit this section of the country. 

The American Medical Association will meet at New York on the 
3rd of May next. 

260 Miscellany. 

Greensboro,' March 10th, 1853. 

At a called meeting of the " Physicians' Society for Medical Ob- 
servation of Greene and adjoining Counties," the following resolutions 
were unanimously adoped : 

Whereas it has pleased an all-wise and mysterious Providence to 
remove by death from our Society, our worthy and highly esteemed 
brother, R. S. Callaway, M. D., of Greene county, and whereas we 
deeply deplore his sudden and premature separation from our fel- 
lowship — 

Be it therefore, Resolved, That our Society has lost one of its most 
zealous and devoted members, and our profession a member of unsul- 
lied character and strict professional integrity. 

Resolved, That we, as a Society, most sensibly feel the void occa- 
sioned by the demise of our brother, and that we will ever cherish 
his memory as a forcible illustration of the true and faithful physician. 

Resolved, That we sincerely condole with the family and friends 
of the deceased, and that we hereby tender them our heartfelt sym- 

Resolved, That we wear the usual badge of mourning for the 
space of thirty days. 

Resolved, That a copy of these resolutions be forwarded to his be- 
reaved family, and that the Southern Medical and Surgical Journal, 
Temperance Banner, Christian Index, and Chronicle and Sentinel be 
requested to publish them. 

JAS. Y. FOSTER, M. D., President. 

D. C. O'Keeffe, M. D., Sec'ry. 

Death of Professor Horner. — It is with profound regret that we 
announce the demise of Prof. Wm. E. Horner, which took place on 
the 12th instant. He was long distinguished as the ablest American 
anatomist, and universally respected for his private virtues. 

The British press announces the death of Dr. George Gregory, the 
author of the once popular treatise on the Practice of Medicine — also, 
that of Dr. Jonathan Pereira, the author of the very learned work upon 
Materia Medica. 

Medical Society of the State of Georgia. — We would remind our 
readers that this Society will meet at Savannah on the 13th of April. 
We hope that there may be a full attendance. 



Vol. 9.] NEW SERIES.— MAY, 18SS. [No. 5. 


©rtgtnal dommunuattotts. 


On Spinal Irritation. By John T. Slaughter, M. D., of 
Villa Rica, Ga. 

The great diversity of opinion relative to the pathology and 
treatment of disease, demands an investigation of all the symp- 
toms which may supervene in the many affections which may 
come within the limits of our observation. Among them all, 
there is none that is so common, or so often escapes the physi- 
cian's notice, as Spinal Irritation; for the reason that there 
is no complaint made by the patient to call his attention to the 
fact that it exists. 

The cause of all the phenomena in intermittent and remit- 
tent fevers, is attributed (by a number of physicians of the 
present day) to lesions of the spinal cord ; and Professor Ford 
has tried to instil into our minds that it is not only always pre- 
sent in these, but may supervene in numerous other diseases — 
which doctrine has so far been corroborated by my own 

The first case to which I shall call attention, is one of Inter- 
mittent fever, which, though it may not be one of much practi- 
cal importance, may serve to throw some light on its obscure 

n. s. — VOL. IX. no. v. 17 

262 Slaughter, on Spinal Irritation. [May, 

Case I. Miss M., aged about 10 years, was taken with 
intermittent fever. Two weeks had elapsed from the com- 
mencement of the attack when the paroxysms were entirely 
replaced by neuralgia of the inferior extremities, of the most 
excruciating character. Portions of the spinal column were 
tender on pressure.. Topical applications relieved her, and the 
administration of quinine prevented a recurrence. 

Case II. Mrs. C, was seized (on the third day of her con- 
finement in childbed) with a chill, followed by fever — with 
nausea, pain in the head, hurried respiration, tenderness on 
pressure over the uterus, tongue furred in the centre with red 
borders, bowels torpid, and the lochial discharge suspended. 
She had been in this situation two days, when I was called to 
see her. On examination, I found a portion of the vertebral 
column morbidly tender. Ordered, sinapisms to the vertebras, 
warm cloths to the vulva, and a dose of the sulphate of mag- 
nesia. By the next morning she was so far relieved as to 
require no farther treatment. 

Case III. Mr. B. was attacked several years ago with 
remittent fever, which terminated in an intermittent. After 
its cessation there was left remaining in the right hypochon- 
drium a sensation of chilliness, which was superseded by erratic 
pains along the course of the ascending colon : this eventually 
located itself in the right iliac region. Bowels costive ; opera- 
tions scybalous and mucous, streaked with blood — afterwards 
constipation alternating with diarrhoea; noise in the abdomen 
resembling the croaking of a frog — worse in the recumbent 
posture ; a sound resembling the dashing of a liquid against 
the parietes of the abdomen, and skin of a dark swarthy hue. 
In the latter stage, troubled with hectic and pain in the left 
side resembling pleuritis. 

This was his state for several years, during which time he 
was reduced to a mere skeleton. He had been subjected to 
treatment for dyspepsia, chronic hepatitis, and phthisis pulmo- 
nalis — exhausted most of the articles of the materia medica 
and patent nostrums of the day without experiencing any re- 
lief. On subjecting him to an examination, I found the third 
and fourth dorsal vertebras very tender to the touch. Con- 
tinued counter-irritants to the spine relieved him, without the 

1853.] D'Alvigny's Case of Frost-bite. 263 

aid of any medicine internally. He still has occasionally a 
slight return of his old symptoms, but the application of a few 
dry cups dispels all unpleasant feelings. 

Here was a disease, with all the symptoms of dyspepsia, 
which must have had its seat in the spinal marrow. But it is 
not only in this disease, but in many others which had with- 
stood ordinary treatment for years, that I have found this the 
most prominent symptom. Beside topical remedies, 1 have 
also found the cold shower-bath to be of great benefit ; and 
from observations which I have made, I am of the opinion that 
it is in such cases as these that Hydropathy wins her laurels. 
This I know, that the sufferings of many might be alleviated 
by the bestowal of the proper attention to this subject. 


A Frost-bitten Scrotum — Gangrene — Recovery. Reported by 
N. D'Alvigny, M. D., of Atlanta, Ga. 

Mr. J. W., a farmer, about 30 years of age, in travelling on 
horseback on the 3rd of January, 1852, had his scrotum frost- 
bitten, and exposed himself to the heat of a large fire, which 
caused itching all over the scrotum, and pain in the back and 
thighs. His condition becoming alarming, medical advice was 
procured on the 5th of the month. 

Drs. S. Malone and W. McKown, of Fairburn, found the 
patient completely prostrated, and in the most excruciating 
agony. The scrotum was of a deep purple, and so much swol- 
len that its bursting was apprehended at every moment ; the 
slightest pressure on it increased the pain dreadfully. The 
pulse was one hundred to the minute. 

6th. Aggravation of symptoms, the scrotum turning black. 

7th. The scrotum bursting at its lower portion gave issue to 
a large quantity of whitish liquid. 

8th. Mortification is complete, and the black color extending 
all over the scrotum. 

9th, 10th and 11th. Mortification progressed to a fearful ex- 

12th. I was called, in consultation. Found the patient very 

264 Dugas, 07i Pharyngeal Tumours. [May, 

feeble, and emaciated ; the scrotum entirely destroyed on the 
left side — on the right side about one inch and a half re- 
mained, not yet mortified, the right testicle being adherent to 
it, and bathed in a mass of putrefaction. Anteriorly the root of 
the penis was the line of demarcation. Posteriorly the perine- 
um was already interested in the disorder, showing a portion 
of the urethra naked. The left testicle was hanging by the 
cord ; both glands perfectly sound. 

I advised to continue the treatment usual in cases of slough- 
ing, viz., the use of chloride of soda, and the administration of 
generous diet, wine and tonics. 

I refused to perform an operation, which, under the existing 
circumstances, could not relieve the patient's sufferings, and 
would probably induce a fatal termination ; but proposed to 
wait until the mortification should be arrested, and then, if no 
appearance of sound and abundant granulation took place, to 
perform castration. 

15th. The mortification ceased, and granulations at every 
point of the sloughing surface formed with astonishing rapidity. 

On the 29th, medical attendance was discontinued, the testi- 
cles being entirely covered with an artificial scrotum. In two 
weeks after the patient was able to go about, and he has since 
experienced no pains nor inconvenience of any importance. 
He is in a good state of health. 

This accident has not deprived those delicate organs of the 
important functions assigned to them by nature. 


Extirpation of Pharyngeal Tumours. By L. A. Dugas, M. D., 

There are no surgical affections more frequently encounter- 
ed than tumours, and yet there are none in which the surgeon's 
skill is so often painfully tested both as to diagnosis and treat- 
ment. If, as has been oft-times repeated, no surgeon however 
experienced should ever advance a positive opinion as to the 
true nature of a tumour before seeing its internal structure, the 
difficulty is, in many instances, not diminished when he is call- 
ed upon to determine upon the propriety of extirpation. — And, 

1853.] Dugas, 07i Pharyngeal Tumours. 265 

even after having advised a resort to the knife, he often finds 
himself surrounded by dangers to the life of the patient, and to 
his own reputation, sufficient to deter any one not firmly con- 
vinced of the propriety of the course to be adopted and of his 
ability to do justice to the patient. 

Why these difficulties ? Do they necessarily attach to the 
diseases in question — or, in other words, has the profession 
given to them the careful attention to which they are entitled ? 
It is true, that we have some good monographs upon the subject 
of tumours, but they are far from being perfect — far from fur- 
nishing to the practitioner all the data he may need on entering 
upon the duties of his profession. The history of tumours to 
be found in the systematic works upon Surgery, is usually so 
meagre as to be worth comparatively but little, except in cases 
of the most ordinary simplicity. It becomes us therefore to 
accumulate and to report facts as they present themselves, in 
order that materials may be at hand for the construction of a 
work consisting not merely of generalities, but also of such 
details as may furnish specimens of whatever may be subse- 
quently observed in practice. A volume that would contain 
nothing more than the history and treatment of individual tu- 
mours, so that we might find in it a parallel for any that we may 
meet, would be invaluable. 

Tumours in the pharynx are comparatively rare, according to 
written authorities as well as our own observation. It may 
therefore serve the purpose to which w T e have just alluded to 
publish the following history of a formidable case recently 

Branch, a negro man about 35 years of age, the property of 
Mr. J. A. Smith, of Henry county, Ga., was placed under my 
charge early in February last. He first noticed about three 
years before, a small tumour behind the soft palate, which he 
represented as being very hard and painless. From that time 
it gradually increased in size, and was never painful, but ra- 
ther inconvenient. I found the tumour filling the pharynx, 
extending upwards to the posterior nares, downwards as far 
as the larynx, and laterally from one tonsil to the other, 
forcing down the right one. The soft palate was carried for- 
wards and downwards, so as to constitute a prominence the 

266 Dugas, on Pharyngeal Tumours. |_IMay, 

size of a large egg, to the posterior surface of which the 
tumour was attached. Deglutition was so difficult that he 
could take no solid food — his articulation was very indistinct, 
and respiration considerably impeded when he would walk 
briskly, causing him then to breathe loudly and like a horse 
affected with the " bellows." 

Believing the tumour to be fibrous, I proceeded on the 10th 
of February to its removal, as follows: 

Provided with actual cauteries, a syringe, sulphate of zinc, 
&c, to control the hemorrhage from the general surface and 
smaller vessels, I passed a ligature beneath the right carotid 
artery, and left it there, ready to be tied should this become 
necessary. The patient was then seated in a chair, and an 
incision made from the right angle of the mouth to the masseter 
muscle — which necessitated the ligature of the facial artery. 
In the third stage of the operation, a longitudinal incision was 
made from the side of the uvula to the roof of the mouth, 
through the soft palate, which was then detached from the tu- 
mour in the form of flaps. The tumour now presented a white 
glistening aspect, and was adherent, posteriorly and laterally, 
to the adjacent parts by strong cellular tissue. Having free 
access to the parts, the cutting instruments were laid aside, and 
the mass was seized with strong tumour forceps and drawn 
forwards, whilst my fingers were passed behind and tore asun- 
der the attachments of the lower portion of the tumour. The 
fingers were then carried successively behind the left, the 
upper, and a part of the right portions of the mass, which was 
now 7 removed. The entire mass thus extirpated constituted 
one distinct tumour ; but there was still another left in the right 
side, apparently in intimate connection with and pressing down 
the tonsil with great force. It did not, like the former, present 
a white glistening surface to the eve, but was covered by a 
thin stratum of muscular fibres, derived from the pharyngeal 
muscles. Upon dividing this stratum with the knife, and 
pressing it aside, the tumour was found to be of the same char- 
acter as the former — and it was likewise removed by the fingers 
and forceps, not however without much difficulty. It was 
found to be attached to the ramus of the lower jaw, near the 
sigmoid notch, to the pterygoid process of the spenoid bone 

1853.] Dugas, on Pharyngeal Tumours. 267 

and to the posterior aperture of the right nostril, and was 
brought away in separate fragments. Both tumours, when 
placed together, formed a mass about the size of a turkey's 

The patient bore this protracted and painful operation with 
wonderful fortitude. The amount of hemorrhage was smaller 
than could have been anticipated, but had to be checked occa- 
sionally by cold water thrown into the pharynx with a syringe. 
After allowing the patient to rest a little, the cheek was stitch- 
ed and well brought together with adhesive strips. He was 
then put to bed with the wound of the neck partially closed, 
and the ligature was permitted to remain beneath the carotid 
until the following morning as a precautionary measure. 

The patient's recovery was unattended with any circum- 
stance worthy of note. He did remarkably well, and would 
have been sent home in about a fortnight, had he not taken 
cold which affected his bowels and induced considerable fever 
for eight or ten days more. 

Will this disease return ? — Microscopic examination by Dr. 
Harriss showed the tumours to be purely fibrous — nothing 
indicative of malignancy could be detected in it. Time alone 
will decide the question. 

The structure of these tumours was very similar to that of 
fibrous polypi, but differed from them in not being pediculated. 
They were, on the contrary, closely attached to all the tissues 
with which they came in contact. From the history given by 
the patient, it appears that there was at first only one tumour, 
and that it was situated behind the velum palati. That in con- 
tact with the right tonsil was of subsequent growth. Would 
the early removal of the first have prevented the develop- 
ment of the second? Some years ago (in 1847) Dr. B., of 
an adjoining county, sent us a case upon which we operated, 
and which has thus far not been reproduced. 

The subject was a negro woman about 25 years of age, who 
presented a tumour about the size of a small hen's egg attached 
to the posterior surface of the velum palati by a broad base, 
about the size of a half-dollar coin. In this instance, instead of 
slitting up the soft palate, we plunged a hook into the centre of 
the protuberance and circumscribed it with a circular incision 

268 Bignon's Case of Dropsy. [May, 

carried through the soft palate, thus leaving entire the lateral 
half arches and the uvula. The tumour was then readily 
drawn through the aperture thus made, for it had no posterior 
attachments. The wound cicatrized completely in a short 
time, leaving no deformity. 
Augusta, March, 1853. 


Case of Dropsy, cured by External Diuretics. By H. A. 
Bignon, M. D., of Augusta, Ga. 

Having noticed in the June No. of your Journal a report of 
cases of Dropsy, treated by external diuretics, I was induced 
to give them a trial. The mixture used consisted of equal 
parts of tr. of digitalis, tr. of squills, and soap, of which one 
drachm was well rubbed over the abdomen three times a day. 

The patient was a negro girl, belonging to Col. M. B : 

she was about twelve years of age, and had been laboring un- 
der general dropsy for some months before coming under my 
care. The chest, abdomen and extremities were very much 
distended, and her respiration very much impeded, so much 
so that I was compelled to tap her, and succeeded in getting 
about three gallons of fluid ; but as soon as the puncture closed 
the abdomen commenced distending again, and she became 
very nearly in the same condition as when I first saw her. 
I then began the use of the diuretic mixture, and in about two 
weeks my patient was well, and has continued so up to this 
time — five months. 

1853.] RicoroVs Letters on Syphilis. 269 


(Eclectic department. 

Letters upon Syphilis. Addressed to the Editor of L'Union 
Medicale, by P. Ricord. Translated from the French, by 
D. D. Slade, M. D. 

[Continued from Page 223.] 


My Dear Friend — To-day I shall speak to you upon syphilis. 
As you can have remarked, I have not lost sight for an instant 
of my point of departure. 

What was it ? To seek out the specific causes of those dis- 
eases considered venereal ; to study in a more rigorous manner 
their mode of action, in order to arrive at last at a more exact 
knowledge of their consequences and of their treatment. 

In the preceding letters, I have endeavored to show that if 
blennorrhagia can have a special cause, it was not alwavs easy 
or even possible to distinguish this special cause from the com- 
mon causes of the inflammation of mucous surfaces. I have 
endeavored to establish that this cause was not that which 
produces syphilis properly so-called ; that its consequences 
were entirely different, and that its treatment, unless empirical, 
cannot be that which we ought to oppose to syphilis. 

I should have been very happy to have merited in all re- 
spects the criticism of M. Vidal, who asserts that my efforts 
have tended only to prove " that two and two make four." If 
I should apply this to all that still passes in syphilopathy, this 
proof would not for every one be equally easy to arrive at. 

The cause of syphilis not existing in blennorrhagia, where 
must it be sought for? 

Do not require that I should precipitate myselfinto the depths 
of history. I have often descended there, and I declare to you, 
dear friend, that I think it impossible to discover the truth there. 
The farther one descends, the less light penetrates, and he ar- 
rives at a point where the obscurity is complete. So that, 
arrived at this point, authors only proceed by groping ; they 
wander about without cessation, and lead us astray with them. 

Where did syphilis commence ? By whom did it commence? 
I much fear that these questions are forever insoluble. What 
we can affirm, is that syphilis, such as we know it at the present 
day, is not developed spontaneously in man ; it appears to be 
always transmitted. And yet, as we have already remarked, 
we do not meet with it in any other class of animals. I well 
know that very recently your Journal announced that syphilis 

270 RicoroVs Letters on Syphilis. [May, 

had just been found in Italy in the horse. In order to believe 
this news, I await some more complete descriptions of the 
symptoms. It would, nevertheless, be rather singular, that 
syphilis, which they accuse of having been propagated for the 
first time in Italy upon the human race, should appear also for 
the first time in Italy upon the horse. 

What strikes every man who studies history without precon- 
ceived ideas, is, to find in the ancient authors, and especially 
in those who were anterior to the epidemic of the fifteenth cen- 
tury, perfect descriptions ofall that we know to-day, and which 
we range among the primary accidents. Could we trace out 
at the present day a description more exact and more true than 
that ofCelsus? Galen goes even so far as to find some rela- 
tion between the accidents of the genital organs and those of 
the throat. William of Sallicet knew that the primary ulcera- 
tions of the penis had been contracted from relations commit- 
ted with filthy women ; he established perfectly the relations 
which exist between ulcerations of the genital organs and bu- 
boes, &c. 

What has been wanting to observers and historians of the 
verole, from the earliest times, is the more exact knowledge of 
the filiation of the symptoms, of the connections and origin of 
the primary and constitutional accidents. But what was the 
leprosy of that epoch? Was the leprosy of the Greeks or of 
the Arabs, which we know to-day, similar to the leprosy of 
those times ? In no respect ; for the leprosy was then often 
contagious, ' and it was frequently communicated by sexual 
intercourse. Evidently it was not our present leprosy. The 
Bible, in spite ofall the efforts of commentators, enlightens us 
but little upon this point. Probably the divine inspirer of the 
sacred books might have had serious motives in leaving some 
obscurity upon this point. I have no pretension to retrospec- 
tive science ; the works of Astruc have frightened me too much, 
and I confess that I am little tempted to undertake so great a 
work for so small a result. But whoever studies syphilis, how- 
ever little he may have his mind tormented by the anxiety to 
know, will ask of himself, what I have done a hundred times, 
what was this terrible epidemic of the fifteenth century, and 
where did it come from. 

Some cotemporaries have made it come from the stars. I 
do not know that they retrospectively searched out what pass- 
ed astronomically at that period, and I am myself unable to do 
it. But it is certain that syphilis always reigns although Jupi- 
ter is to-day much more temperate, and Saturn and Venus no 
longer deliver themselves up to conjunctions which had such 
unhappy consequences for the human race. We are, then, 

1853.] RicoroVs Letters on Syphilis. 271 

forced to seek our explanation upon the earth, and to take our 
subject from a less elevated point of view. 

This terrible epidemic, this veritable 'S3 of the verole (1493), 
which no cotemporary at first thought of making come from 
the new world, found this origin in the writings and in the ac- 
tive propagandist) of Oviedo, from motives into which it is 
useless to enter, and of which we shall find the application in 
the religious, political and Jesuitical history of the time. We 
know that it is this fable which has become the theme of the 
great romance edited by Astruc. Heaven preserve me from 
discussing this ; it is a work that has already been well done 
by Sanchez. I will allow myself only a slight observation in a 
pathological point of view. 

In order to have brought about an epidemic upon such a 
grand scale, it must have been necessary that all or nearly all 
the sailors of Christopher Columbus should have been infected 
with syphilis. It was necessary that during a very long voyage, 
which was then not made by steamers, the primary accidents 
should have remained at the period of progress or of specific 
statu quo, susceptible of furnishing the contagious pus that we 
shall soon study. 

One thing is very remarkable, that the sailors of the fleet, 
having arrived at Lisbon and at Bayonne, did not first infect the 
women of those ports: and yet is it probable, that contrary to 
the habits of sailors of all times, these should have, after along 
voyage, exercised continence after arriving in harkor ? Well, 
it is not to the women of Lisbon and Bayonne, that they com- 
municate their disease ; they leave for Italy where they go to 
meet the army of Gonzalve de Cordova in May, 1495, and it is 
there that they communicate the verole — to whom ? We 
know nothing excepting that it was in Italy in the midst of 
three armies — Spanish, Italian and French — that a disease, then 
known since 1493 or 1494, raged with fury, each of the bellig- 
erent parties repelling the disgrace of communicating it to the 

I do not wish to insist longer upon this historical question so 
confused and obscure, and which I have not the pretension to 
wish to clear up. I only ask myself if this epidemic of the 
fifteenth century resembles our venereal diseases of the present 
day ; and I find certainly not. The accidents that we observe 
to-day resemble infinitely more those that the ancients have 
described, than the epidemic of the fifteenth century. 

Here, my friend, permit me to communicate to you, with the 
reserve and the discretion which similar things exact, an idea 
which I believe to be a fruitful one. I submit it as a simple 
indication to some young and industrious colleague, who shall 

272 RicoroVs Letters on Syphilis. [May, 

have the good fortune of finding himself in that happy period 
when consistent researches are possible. In studying with 
care the descriptions of the epidemic of the fifteenth century, 
I am struck with a fact, which appears to me to be of marked 
interest. The mode of the transmission of the accidents, their 
gravity, the predominance of the constitutional infection over 
the local phenomena, which are wanting, or which passed un- 
perceived, all this appears to me to resemble much more what 
we recognize to-day as the acute glanders, and the farcy, than 
the verole. Van Helmont has published an analogous idea, 
which has not failed to have been considered perfectly ridicu- 
lous. He makes the verole come from the farcy, as the conse- 
quence of I do not know what ignoble beastly relations. Apart 
undoubtedly from the shameful source from which he drew his 
opinion, Van Helmont was perhaps not far from the truth. 

Remark, my friend, that a knowledge of the glanders and of 
the farcy in man is very recent, and yet the liability of man to 
contract this disease, which has existed from all time in the 
horse, ought not to be a recent fact. How many men suffer- 
ing from the glanders and from the farcy have been liable to be, 
and have been, taken for syphilitical patients ! 

The manner of the transmission of the epidemic of the 
fifteenth century ought to strike us. The disease was often 
communicated by the breath in churches, in confessionals, to 
such an extent that Cardinal Wolsey, accused of having the 
syphilis, was brought to judgment for having spoken in the ear 
of Henry WIL This mode of propagation is entirely inexpli- 
cable for syphilis, which requires an immediate contact. I well 
know that all the authors of the time do not admit this mode 
of transmission by the sole contact of the breath. Fallopius 
ridicules very pleasantly Victor Benoit, who had seen some 
holy daughters of a convent catch the verole through the thick 
grates of the parloir. Fallopius believes that there was mixed 
with this, a little holy ivater. But in all cases could not the 
epidemic, which certain authors already, and Paracelsus among 
others, considered as a mixture of the ancient venereal diseases 
and of the leprosy, be more probably considered as a mixture 
of the ancient venereal diseases with the glanders and farcy — 
the glanders, so spontaneous and easily produced upon horses, 
and especially in time of war, and with the incumbrances which 
follow in its trail. 

Study the symptoms, and you will first see manifested, and 
as if oVembUe, the gravest accidents ; which does not happen 
with respect to the syphilis of the present day. You will see 
that inoculable pus was produced in all parts of the body, which 
you do not see in the syphilis now known to us. J do not 

1853.] Ricord's Letters on Syphilis. 273 

know if I am mistaken, but it appears to me that there is in 
this, a truly remarkable subject for research. I seem to see 
the first dawning of a truth which has escaped us, even to this 
hour. We shall owe this truth to the beautiful works of M. 
Rayer, and of his school, and of M. Renaud (of Al fort) upon this 
terrible disease with which man is found so sadly endowed ; 
and in which I find such striking resemblances with the epi- 
demic of the fifteenth century. What glorious things there are 
to be done in this matter! 

Are we aware of what the glanders, transmitted from man 
to man, and removed from the horse, can produce ? Do we 
know what its hereditary influence is ? For individuals suffer- 
ing from the glanders or from farcy can procreate, and we are 
completely ignorant of what would become of the product of 
these procreations. 

I should be happy to awaken the zeal of some laborer in our 
science. There is here, it seems to me, an ample harvest of 
glory to reap. But I confess it, all these ideas are still agitated 
in my mind, in the vague domain of hypothesis. Your readers 
I can understand must be desirous to see me enter into the field 
of reality. I arrive there : adopting the conclusion of Voltaire, 
I say that syphilis is like the fine arts, of which no one knows 
the origin nor the inventor. But what I know is, that it is found 
to-day at a source, alas, too certain, and it is from this source 
that I shall draw it in my next letter. 


My Dear Friend, — We must now determine the source, 
where the specific cause, the morbid poison which produces 
syphilis, is to be found. This poison, we can at the presant 
day call by its name, the syphilitic virus. 

Well ! this virus — I must needs recall the circumstance, in- 
asmuch as endeavors have been made to cause it to be forgot- 
ten — was formally contested and denied, when I undertook my 
first researches in syphilopathy. This was the time when nu- 
merous physicians did not dare to give it this name without fear 
of compromising themselves. It was the time when the learned 
Jourdan, in an access of singular anger, cried out — " : call it as 
you will, but do not give it the name of virus." 

The source of this virus, I have obtained at the point of the 
lancet, upon which, however, I have not had the pretension of 
placing all science, as my honorable colleague, M. Cazenave, 
wittily accuses me. 

It is in studying comparatively all the accidents reputed sy- 
philitic, that I have succeeded in demonstrating that one alone 

274 RicoroVs Letters on Syphilis. [.May, 

of these accidents would furnish regularly the purulent matter ; 
capable, in placing it under conditions which we shall deter- 
mine, of producing, in virtue of a special irritation, an ulcera- 
ting inflammation identical to that which has been the source 
of it, and of reproducing in its turn the same special secretion, 
the same morbid poison, and this without limit. 

The syphilitic lesion, source and origin of the secretion, 
placed in favorable conditions, produces fatally the phenomena 
which we have just indicated, and which is the primitive acci- 
dent to which has been given, and which has preserved the name 
of chancre. 

Every time, as I have already had occasion to remark, that 
we were able to see the surfaces from which we took the morbid 
secretion, which should serve for experimentation, it is only 
when there existed a chancre, that positive results could be ob- 
tained, and that we were able to reproduce the chancre. 

Must I again say that my excellent colleagues, M.M. Puche 
and Cullerier, at Paris; M. Baumes and Diday at Lyons; M. 
Renault at Toulon, Serre at Montpelier, M. Thiery at Brussels, 
M. Lafont Gouzy at Toulouse, &c, have arrived in their very 
numerous experiments, absolutely at the same results as myself. 

Every time that the chancre could be produced with a secre- 
tion which had not been taken immediately from a primary 
ulcer, the secretion was furnished by surfaces which could not 
be inspected. The small number of cases, exceptional in 
appearance, in which the chancre could be reproduced with a 
purulent matter taken from a non-ulcerated surface, find their 
rational and absolute explanation in facts analogous to those of 
which I have recounted the history. How can it be concluded 
that the surfaces which cannot be inspected are not the seat of 
chancre, inasmuch as they furnish absolutely the same secretion 
as the chancre ? Ah ! if it was proved that the primary ulcer, 
fatal source of the syphilitic virus, could not be seated, excep- 
ting upon external surfaces which are always visible ; that the 
depths ofthe urethra, and the cavity of the neck of the uterus, 
could not be the seat of these concealed ulcerations — if this was 
proved, all would be said ; but does there exist one sole writer 
upon syphilis who denies the existence ofthe primitive ulcer 
upon all these regions, who does not know and who does not 
believe that all syphilitic ulcerations are not always visible ? 
How, then, can we deny the possibility of the existence of deep 
and concealed chancre, when it in itself furnishes the most un- 
deniable proof, that is the secretion? 

It has been said that inoculation cannot serve any purpose in 
proving the existence ofthe specific cause of syphilis; that it 
was preferable to confine ourselves to the ordinary results of 

1853.] RicoroVs Letters on Syphilis. 275 

contagion to arrive at this proof; for with any pus whatever 
we can produce what I pretended to produce only with the 
pus of the chancre, while by the mysterious ways of common 
contagion phenomena are observed, which inoculation does not 

It is at least strange that these same arguments are equally 
employed, both by the maintainers of the syphilitic .virus, and 
by those who deny its existence. In fact what do these physio-* 
logists say ? That with any pus whatever, that with a cause 
no matter what, the same result was arrived at — that is to say, 
the production of every variety of venereal disease. And upon 
what do they rely to sustain this doctrine? Upon motives 
which could then appear reasonable ; upon all the uncertainties 
which ordinarily exist under the circumstances in which the 
venereal diseases are contracted ; for the want of examination 
of women ; upon the great number of the accidents determined 
by the same woman upon several men while this same woman 
could leave other men entirely indemnified from evil consequen- 
ces ; finally, upon all the fables that we have already signalized 
and combated, and upon which one is truly astonished, after 
what the speculum has discovered, to see men of merit as incon- 
testable as M. Cazenave wish still to ground superannuated 

But I am profoundly astonished that the partizans of the 
syphilitic virus, those who recognize in syphilis a specific cause 
and in its virus a specificity of action, sustain, that with any 
pus whatever effects can be produced analogous to those of the 
inoculation virulent par excellence. Do the partizans of these 
doctrines think that we could produce vaccinia or the variola by 
any kind of pus ? If it was given to them to experiment upon 
purulent matters the source and origin of w T hich they were 
ignorant, what would be their criterion for determining the 
nature of them, if it was not the effects produced ? Is it not in 
this way that I arrived at distinguishing the syphilitic pus ? 

But to this objection of any pus whatever as proof of the inu- 
tility of inoculation, I have another thing to answer. 

I have inoculated the same patient, and that a hundred times, 
with the pus of chancre, of balano-posthitis, with the muco pus 
of urethral blennorrhagia, with the muco-pus of blennorrhagic 
ophthalmia, with the pus furnished by the phlegmonous inflam- 
mations of other regions; and while that of the chancre inev- 
itably reproduced the chancre, the other kinds of pus remained 
without action. What do they want more than this proof, 
and what can they answer to it ? 

Another objection, however, has been made. They have 
said, the inoculation does not prove anything as to the nature 

276 RicoroVs Letters on Syphilis. [May, 

of the cause, from the effects that it can produce upon an indi- 
vidual already submitted to the infection; in other words, in 
inoculating the patient with the secretion that he himself fur- 
nishes, no conclusion can be arrived at, inasmuch as that if in- 
fected every wound can and ought to become syphilitic. 

Herein is a strange error, the consequences of which might 
be very grave ; a dangerous prejudice, which I am astonished 
.to see again brought forward in our day with the sanction of 
observers who make pretentions to exactitude and precision. 
The facts which I have just recalled peremptorily destroy this 
objection. I well know that facts relating to leech-bites, for 
example, have been cited, which have taken on later the char- 
acter of venereal ulcers. But be assured, my friend, these bites 
like every wound in a syphilitic patient, do not become viru- 
lent ulcers, unless they are finally infected by contagion. Ap- 
ply leeches where there has been no contact with inoculable 
pus, bleed the syphilitic patients as much as you wish, practise 
any other operation whatsoever, and never, unless there has 
been virulent contact, will a virulent transformation be possi- 
ble. Among the numerous observations, which I have collect- 
ed in proof of the truth of this assertion, I will recall the follow- 
ing fact of the Hospital du Midi. 

At the period when I had women in my wards, a patient af- 
fected with a phagedenic chancre of the vulva, with abundant 
suppuration, was seized with a pain in the tibio-tarsal articula- 
tion. Leeches were applied upon the painful spot. Some days 
after the patient complaining at the seat of the bites, it was easy 
to recognize that some had undergone a veritable transforma- 
tion, and that they had become^veritable chancres. One could 
believe for a moment in the influence of the general condition 
of the patient, and some of the students Relieved in it. As to 
myself, I had not the least doubt upon the mechanism of this 
transformation. In the first place, all the bites were not ulcer- 
ated — first proof. Secondly, the patient was seized with similar 
pains in the articulation upon the opposite side ; a new applica- 
tion of leeches was made, but this time, in guarding the bites 
from every infecting contact, none of them underwent the 
least syphilitic transformation. 

I have made an experiment more conclusive still. It has 
often happened that I had to experiment with the pus of a chan- 
cre upon a patient even then under the influence of a constitu- 
tional syphilis determined by a preceding contagion. Some 
comparative inoculations were made, and then again the mat- 
ter of the chancre alone gave place to positive results. Thus, 
whatever may be said, it is impossible to compare a syphilitic 
patient to a bottle full of virus, which it would allow to escape 

1853.] RicoroVs Letters on Syphilis. 277 

through the smallest opening. The image is poetical, but it is 
not just. 

But in order that these results should be inevitably obtained, 
reason tells us, in the first place, that the virulent matter ought 
to be taken from a chancre at a certain period — that is to say, 
at the period of progress, or of specific statu quo. It is very 
easy to conceive this, and I am sure of not fatiguing you in try- 
ing to make you understand that if you take the pus for inocu- 
lation from the surface of an ulcer which is in process of repar- 
ation and of cicatrization, you will have a simple and inoffen- 
sive pus, which will give you negative results, and that the 
same accident interrogated at two different epochs will say to 
you, yes and no. You will conclude, then, with all observers 
of good faith, that there is here no contradiction in the results of 
experimentation, nor uncertainty, and that it is no evasion, no 
subtility of doctrine, to explain facts opposed to the principles 
which I sustain, and similar to those of Bru. When Bru did 
not succeed in inoculating the pus of chancre, one of two things 
happened ; either he made a false diagnosis and directed his 
attention to other ulcerations, or he took the pus from chan- 
cres at the period of reparation. There is no way of escaping 
from this dilemma ; for I repeat it, and I am ready to prove it 
to the incredulous, if there are any still, the pus of the chancre is 
inevitably inoculable. 

You will perhaps find, my friend, that I suffer myself to go 
too far in the pleasure of writing to you ; but it is your fault, 
you never stop me. Profiting, then, by your good will, I will 
say that if the virulent matter composed of a special morbid 
poison and of a vehicle, is ordinarily formed of a thin, ichorous, 
sero-sanious pus charged with organic detritus, it does not 
always present itself with the same characters ; it can offer all 
the known varieties of pus or of muco-pus. It can be acid or 
alkaline, contain animalcules or not. These different conditions 
which appear contradictory, and have also served as an argu- 
ment to those who deny the existence of a virus, belong only to 
its vehicle, and change nothing of its nature, which remains 
always the same. There is but one circumstance important 
to signalize, and which experiments upon inoculation have 
verified — viz. that the putrid pus is not virulent, that gangrene 
destroys the virus — it kills it. 

In order to act, whatever may be the seat of the chancre from 
which it has been taken, the virulent matter has no need of 
being recently secreted and warm. Preserved as vaccine is, it 
acts equally well. Artificial inoculation proved this, contrary 
to the opinion of Cullerier, which hitherto was in vogue in 

n. s. — VOL. IX. no. v. 18 

278 Ricord's Letters oh Syphilis. [May, 

Inoculation has proved the truth of the different modes of 
contagion, more or less contested, so far as necessity of the phy- 
siological action and of the orgasm of the part which furnished 
the contagion was believed in, and as it was thought that this 
ought to be yet warm at the time of infecting. The observa- 
tions of Fallopius and Hunter of chancres contracted in touch- 
ing the seats of public privies; those of Fabricus of Hilden of 
accidents taken in sleeping in sheets in which infected persons 
had already slept, and of so many others, in fine, have thus 
become incontestable. 

You will still permit me to say a word upon the conditions in 
which the part which one inoculates ought to be. Whatever 
it may be, skin or mucous surface, no matter what region, it 
suffices to have a simple solution of continuity without the aid of 
any physiological act, in order that the effect should be inevita- 
bly produced: there is nothing here, as in the case of the variola 
and vaccine, which resists the primitive accident ; there is no 
privilege of idiosyncrasy ; the most perfect equality exists in the 
presence of a point of a lancet charged with virulent matter. 

Thus, then, dear friend, the inoculation made with the pus 
coming from a primary accident, with the pus of a chancre, in 
the condition which I have just recalled, has always produced 
identical results, whether experimentation has had for subject 
the patient who furnisned the pus, or whether the pus has been 
inoculated from an infected to a healthy individual, as some ex- 
perimenters have done. 

It has however, again been said — it is imprudent, rash and 
impossible to conclude anything from artificial inoculation; 
you impose upon nature conditions other than those in which she 
is placed during the contagion which we can call natural by con- 
tradistinction. And condemning this artificial inoculation, they 
thought they could say of it what is said of physiological exper- 
imentation — " Torture demands and pain responds/ 

Our celebrated physiologist M. Magendie, to whom you ad- 
dressed your first, and so remarkable medical letter, will tell you 
what he thinks of this indignation of the poets. As for myself, 
who do not wish to speak with the same authority, I shall say 
that I do not contest the mysteries of nature, that I know she 
does many things by processes which she conceals from us. But 
I maintain, also, that it would be an unworthy weakness to seek 
to render her still more mysterious, and to thicken the veils 
which cover her; that it would be shameful to shut our 'eyes 
when she wishes to unveil herself. 

Let us see, then, if there exists any real difference between the 
natural and the artificial contagion. I shall tell you what I think 
of this in my next letter. — [Boston Med. and Su?*g. Journal. 

1853.] Treatment of Syphilis. 279 

On the Treatment of Syphilis. By Prof. Bennett, Edinburgh. 

[The following remarks are taken from No. 8, of Dr. Ben- 
nett's very valuable Clinical Lectures :] 

The treatment of syphilis may be said to be of two kinds, — 
namely, the simple and the mercurial. The profession are rap- 
idly deciding in favour of the first, although some of its mem- 
bers still give mercury in inveterate cases. Many of those we 
meet with, therefore, have taken the drug, and we have to erad- 
icate the effects of the mineral poison as w T ell as that of the 
original disease. 

The Simple Treatment is divided into internal or medical, 
and external or surgical. The first consists in the observation 
of certain hygienic rules, and the employment of general thera- 
peutic means. The diet must be light and mild, meat and all 
stimulating viands retarding the cure; even with the lightest 
diet the hunger should never be quite appeased. The regimen 
must be the more diminished and rigid in proportion to the 
youth and vigour of the patient. Diluent beverages, decoc- 
tions of barley, liquorice, and linseed, alone or mixed with milk, 
should be taken freely, to the amount, indeed, of several pints 
a day. Perfect repose must be secured by confinement to bed. 
Constipation must be obviated by the use of emollient clysters 
or mild laxatives. The air should be maintained at the same 
temperature ; this is an indispensable precaution in chronic, con- 
secutive, and mercurial affections. Exercise is only useful in 
the convalscent stage. In chronic syphilis, however, it may 
often be carried to fatigue with advantage. Tepid baths, repea- 
ted three or four times a day, are always attended with advan- 
tage. General blood-letting is often required where the prima- 
ry disease is intense, or the system excited and the patient ple- 
thoric, but should not be used indiscriminately. 

In the external or surgical treatment, strict attention to 
cleanliness and the position of the diseased parts should never 
be lost sight of. Emollient decoctions or fomentations, or dres- 
sings of simple cerate, are the best applications, and the dres- 
sings should not be too frequently renewed. Leeches are gen- 
erally necessary. The greatest benefit is derived from the 
external use of a concentrated solution of opium (in the propor- 
tion of about two drachms to one ounce of water ;) it soothes 
excessive instability in all cases. When the suppuration is 
moderated and the surface of the ulcer clensed, stimulating dres- 
sings, consisting of solutions of the sulphates of alum and cop- 
per, the nitrate of silver, and subacetate of lead, favour cicatri- 

In inveterate cases, more especially those labouring under 

280 Treatment of Syphilis. [May, 

tertiary symptoms, the iodide of potassium was introduced by 
Dr. Wallace, of Dublin, and used by him with considerable suc- 
cess. I have myself given it in numerous cases with benefit, 
in doses of five grains, three times a day, conjoined with emolli- 
ent applications to the affected parts. 

The Mercurial Treatment consists in keeping up slight sali- 
vation, by means of the internal administration of blue pills or 
some form of mercury, sometimes conjoined with mercurial 
frictions or fumigations, at least for the space ofa month This 
physiological action of the drug may be produced by adminis- 
tering any of its preparations continuously in small doses. If 
combined with opium, they act less on the bowels and more on 
the system generally. 

It is necessary during its action, that the patient do not expose 
himself to cold. A certain irritability is produced, and the con- 
stant soreness of the gums, the metalic taste in the mouth, not 
to speak of the inconveniences of profuse salivation which oc- 
casionally occur, render this species of treatment anything but 
agreeable to the patient. 

Both kinds of treatment have now been extensively tested. 
In the year 1822, the Royal Council of Health, in Sweden 7 
having been charged by the king to conduct a series of experi- 
ments upon the different modes of treating venereal diseases,, 
reports from all the civil and military hospitals were ordered to- 
be drawn up anually. These reports establish the inconveni- 
ences of the mercurial system, and the superior advantages of 
simple treatment. In the various hospitals of Sweden, 40,000 
cases have been done under treatment, one half by the simple 
method, the remaining half by mercury; the proportion of re- 
lapses have been in the first instance, seven and a half, in the 
second, thirteen and two-thirds, in one hundred. Dr. Fricke T s 
experiments in the Hamburgh general hospital were first made 
public in 1828. In four years, out of 1649 patients of both sexes 
582 were treated by a mild mercurial course, and 1067 without 
mercury, the mean duration of the latter method has been fifty- 
one days, and that by mercury eighty-five. He found that re- 
lapses were more frequent, and secondary syphilis more severe 
when mercury had been given. When the non-mercurial 
treatment was followed, they rarely occurred, and were more 
simple and mild when met with. He tells us that he has treated 
more than 5000 patients without mercury, and has still to seek 
cases in which that remedy may be advantageously employed. 
He has never observed caries, loss of the hair, or pains in the 
bones, follow his treatment, and in all such cases which have 
come under his care, much mercury has been given. 

In 1833, the French Council of Health published the reports 

1853.] Treatment of Syphilis, 281 

sent in by the physicians and surgeons attached to regiments 
and military hospitals in various parts of France. Some of the 
reports are in favour of a mild mercurial course, others in favor 
of simple treatment. They all agree by stating the cure by 
mercury to be one-third longer than by the other treatment. 
At Strasburg, mercury was only given to very obstinate cases. 
Between 1831 and 1834, 5271 patients had been thus treated, 
and the number of relapses and secondary affections calling for 
the employmeet of mercury had been very small. No case 
of caries, and only one or two instances of exostosis, had been 
observed. Full reliance may be placed on these facts, as 
regiments remain in garrison at Strasburg for five or six 

In the various reports now published, more than 80,000 cases 
have been submitted to experiment, by means of which it has 
been perfectly established that syphilis is cured in a shorter 
time, and with less probability of inducing secondary syphilis, 
by the simple treatment. 

These facts are now very generally admitted, and malignant 
syphilis is gradually disappearing. Twenty years ago, the most 
frightful secondary and tertiary cases were met with, and the 
usual treatment was profuse salivation. At present, such cases 
are rare. Abroad, owing to the wise police regulations, the 
disease is infinitely more innocent even than it is at present in 
Scotland ; and under the salutary influence of a mild and simple 
treatment, its virulence is daily abating. 

In appreciating the value of this important revolution in 
practice, we should not forget to eulogize those who had first 
the boldness to introduce it. The credit of this is mainly due, 
in England, to Mr. Fergusson, and other British army surgeons, 
who practised it during the Peninsular campaign ('Medico-Chir. 
Trans.,' vol. iv.,) and to Mr. Rose, of the Coldstream Guards 
(Ibid. vol. viii.) In Scotland, the writings and lectures of the 
late Professor John Thompson, of this university, were mainly 
instrumental in convincing Scotch practitioners of the evils of 
mercury in venereal diseases. In England, the Hunterian theo- 
ry and practice have been deeply rooted, and in Ireland have 
been supported by the writings of Carmichael and Colles. Mer- 
cury in consequence is still very generally employed in those 
parts of the kingdom. The gigantic experiments made abroad 
however, ought to convince the most sceptical ; if not, let them 
compare what syphilis is in Scotland with what it was, and 
especially observe that we never see an instance of the disease 
such as that now in the ward (Case 1,) unless the patient's sys- 
tem has been contaminated with mercury. — [Lancet. 

282 Change of Color in an Adult Negro. [May, 

Change of Color in an Adult Negro. By A. Hammer, M. D., 
of St. Louis. 

We are very much indebted to Messrs. Br and D , 

JVC. D., in this State, for their kindness in giving us an opportu- 
nity of seeing and examining a very interesting case. It is a 
negro, named Joseph Daniel, born in Woodford county, Ken- 
tucky, residing now in Saline county. Missouri, who is a slave, 
of Richard Robertson. He is five feet seven inches high, forty- 
three years of age, stout, and appears healthy, has never been 
ill, save transient rheumatic pains in various parts, and is at 
present suffering from slight pains in the right knee. He is, 
from the testimony of the highest authorities, born from black 
parents. His present condition, differing from that of his 
infancy and boyhood, is the following: 

The whole frame, and especially the formation of the skull 
and features, present all the characteristics of a full-blooded 
negro. The color of the skin of the whole body is white, like 
the Caucasian race, that is. entirely dissimilar to that of the 
Albinos, but as natural as it can be in a white man, with the 
exception of the face ; and a few spots varying from the size 
of the head of a pin to that of a five cent piece, on both wrists 
and the sternum, which spots are quite as black as in the ne- 
gro — form and color of the nails being as natural as in the white 
man. The face is partly white and partly black, or rather 
darkish-brown. The lower portion of the face, from the nose 
downwards and bounded on either side by the anterior border 
of the masseter muscle, is entirely white, with the exception of 
a narrow stripe of black on the inferior lip, extending trans- 
versely across it on a line with the mouth. On the upper lip 
there is a similar stripe of black, broader than that just men- 
tioned, extending upwards on the right side to the ala nasi. 
Both ala nasi are black. At the union of the nasal bones with 
the nasal cartilages a black stripe, from three to four lines wide 
traverses like a saddle the bridge of the nose, communicating 
on both sides with black surfaces on the cheeks; all the rest 
of the nose being white. Both cheeks, including the orbital 
regions, form a continual blackish-brown surface, each one 
being a triangle, more or less rectangular, and connected with 
each other by the above-mentioned saddle. The triangular 
blackish-brown surfaces spoken of occupy a large space on 
both sides of the face, and may be described in the following 
manner : — The superior side of each triangle corresponds with 
a line drawn from the internal angle of the supra-orbital arch, 
running backwards over the arch and somewhat downwards to 
the zigomatic process ; the inferior side commencing from the 

1853.] Change of Color in an Adult Negro. 283 

point of termination at the zigoma, passing downwards and 
forwards to the anterior edge of the masseter muscle at its at- 
tachment to the inferior maxilla; the anterior side is described 
by a line uniting the last point with the point at which it start- 
ed — viz., the internal angle of the supra-orbital arch. It must 
not be understood, that these lines are strictly mathematical. 
They are irregular and somewhat denticulated. The forehead, 
with the exception of a few irregular spots of various sizes 
scattered over its surface, is entirely white. Strange to say, 
there is a white circle of about an inch in width, encircling the 
whole face, bordering superiorly the hair of the head, and run- 
ning downwards on either side of the face over the masseter 
muscles and passing over the inferior part of the face. The 
ears are covered with minute spots of a blackish-brown color, 
giving to them a freckled appearance. The whole scalp is 
white. The hair is short, and as in the genuine negro, curly, 
being partly black and partly grey — the grey hairs most nu- 
merous at the temples — the eyes are those of the negro. The 
formation of the eyeball and its appendages is normal. All 
membranes and visible organs healthy, the cornea excepted, 
upon which in both eyes a complete arcus senilis, broad and 
corresponding to the whole circumference of the cornea, is 
visible. The conjunctiva is of a dirty-yellow tint, the pig- 
ment unimpaired, the iris of a beautiful brown color, sight per- 

The hair on the mons veneris are fine, slightly curled, and 
yellowish white, but not colorless as in the albinos ; of the 
same quality are the hair surrounding the anus and on the ex- 
tremities. Those parts of the skin, which are white but ex- 
posed to the influence of the sun, as the throat, neck, anterior 
part of the chest, and hands, present a sunburnt appearance, 
and the epidermis upon them is very much wrinkled. His 
mental faculties are of a low order. 

I have in my possession a Daguerreotype of this man, and 
have caused another to be taken at the Daguerreotype Gallery 
of Messrs. Dobyns & Spaulding, corner of Fourth and Olive 
streets, where any one having the curiosity to inspect it may 
have an opportunity of doing so. 

History of the Case. — We have the most reliable testimony 
that this negro is descended of entirely black parents. He was 
black at birth, remained so up to his sixteenth year, when he 
was bitten in the scalp by a healthy dog, being unaware at the 
time of the dog's approach. The wounds received were not 
serious. About two weeks afterwards, however, his hair, 
which was before black, commenced turning grey. At the 
same time, the deep black of the general surface of the body 

284 Change of Color in an Adult Negro. [May, 

became uniformly lighter, some places becoming entirely white, 
while the surrounding parts remained of a light brown color. 
The white places mentioned, gradually increased in size, until 
the whole body was as white as we have above described. 
This change of color went on, from his 16th to his 25th year. 
From this time, up to the present, a period of eighteen years, 
his condition, as regards color, remains unchanged, with the ex- 
ception, however, that the black patches on the face were eigh- 
teen years ago somewhat lighter than they are now. We are 
told, that they neither increase nor diminish in size, but in color, 
their intensity is influenced by the seasons. At twenty-five 
years of age, when the change in the color of his general 
surface was perfected, he married a full-blooded negress of a 
genuine black color. He has a son now seventeen years of 
age, well formed and vigorous, and as black as his mother, and 
not a single indication of approaching change like that of his 
father up to this time exists. 

Remarks. — This case of a change in the color of the skin of 
the negro stands not alone. Several cases are cited, by Blu- 
menbach, Bates, Gualtier, Le Cat, Rayer, Fisher, Rush, [vide 
Cyclopededia of Anatomy and Physiology, by Robert B. Todd, 
Part 1st, second Edition, London, page 86, in a note :] by Byrd, 
Jefferson and Morgan, [vide Lectures on Physiology, Zoology, 
A. S. O. : by W. Lawrence, Salem, page 265, in a note ] 

No one of these cases, quoted by the authors mentioned cor- 
responds entirely with our own, some being instances of com- 
plete albinism in the negro, other's instances of a change in 
color, by no means so extensive, or involving such an amount of 
surface as this case. Among the cases of partial change, men- 
tioned by Le Cat, one was, in his opinion, the consequence of 
a severe burn or scald. 

The question now arises, how has this change been brought 
about, or in what does it consist? It is a question which' na- 
turally occurs to the mind of every one, but is by no means 
susceptible of a satisfactory solution. 

We will, nevertheless, venture upon a few remarks, leading 
the attention of our readers to some of the more prominent 
features of the case, which seem to throw, at least, some light 
on this dark question. The case differs, as we have before 
said, from that of the negro-albino. Albinism is generally at- 
tributed to a decay and an arrest of development of the pig- 
mentary cells — to a qualitative change of the blood. 

With this explanation, we are usually content, though it is 
very unsatisfactory, in as much, as it does not explain the cause 
of this change. 

The usual explanation of albinism is not at all applicable to 

1853.] Change of Color in an Adult Negro. 285 

# our case, for the pigmentum nigrum is seen on some parts of 
the surface. The blood cannot, consequently, be changed. 
There is merely an irregular distribution of the pigmentum, or 
rather the absorption of its elements from the capillary vessels 
is limited to a few select points. 

We presume nobody will be so senseless as to assert, that 
the blood-vessels of any particular region of the body have a 
predilection for the elements of the pigmentum nigrum, and 
that they are not equally distributed throughout the whole cur- 
rent of the circulation. The irregular distribution of the pig- 
ment is good evidence to the exclusive humoral-pathologist of 
the part, which the tissues, or so-called solids, play in nutrition 
and the metamorphosis is of tissue. It is needless to add, that 
both, fluids and solids, are equally active, and that an error in 
either can give rise to a pathological state. Our suggestion is, 
then, that the entire act of metamorphosis, of tissue in the cutis, 
\rete Malpighi,~] is changed in this case in such a way, that the 
tissues (solids) have lost the power of attracting from the capil- 
laries the elements of the pigment, and that this power of at- 
traction is preserved, unimpaired, only in a few places. If we 
draw too definite a line between fluids and solids, as the ex- 
clusive humoralists and exclusive solidarists usually do: we by 
no means attach to this distinction an antithesis, for we recog- 
nize, in the human organism, no separation of fluid from solid, 
but view them as the unity of organization, each having its 
special attributes, and between them a mutual dependence. 
We have been forced to make this remark, because of the dif- 
ference existing between the schools. 

Now, if an abnormal physiological act takes place, or a 
pathological condition occurs, and the blood (fluid) is evidently 
unchanged, we necessarily look to the solids, for the cause of 
the change. 

Though we know very little of the part which the so-called 
solids, viz., bone, cartilage, fibrous tissue, &c, play in the pro- 
cesses of life — there is one tissue, viz., the nervous, of which a 
great deal is known, and much established. Our attention, then, 
in speaking of the solids, must be principally directed to this 
tissue — as it may be considered the representative of the solids. 
We would say, in one word, that we attribute a pathological 
condition, under such circumstances, to a, perversion of inner- 

We must now recall to our readers, the fact, that this negro 
was bitten by a dog; that he is of a low order of mind, and 
that his change of color commenced immediately after this 
accident. Farther, we must note the fact, that, in one of Mr. 
Le Cat's cases, the change of color was immediately preceded 

286 Fracture of the Processus Dentatus. [May, 

by a burn or scald, and that Le Cat considers the accident the. 
cause of the change. We must farther remark, that in the 
Annals of Medicine, cases are related, in which the hair 
changed from black to white, in a single night, from excessive 

We allude to these instances, not in the hope of building up 
an infallible theory, but as matters worthy of some considera- 
tion. Would it appear unreasonable or absurd, to suppose, 
that a continued perversion of innervation is the result of ex- 
cessive mental emotions? We are inclined to think not. 
Similar perversions of innervation, only lower in degree and 
less continuous, as far as the result is concerned, are of every 
day's occurrence, and nobody seems to be much astonished at 
them, while frequently occurring. This idea, which we have 
advanced, is but an hypothesis, and we do not contend that it 
explains the whole process. It remains for us to show the na- 
ture of the supposed perversion of innervation ; but the present 
state of medical science does not enable us to do so. — [St. Louis 
Med. and Surg. Journal. 

Fracture of the Processus Dentatus— fatal only 5 months after. 

[Professor Parker relates, in the New York Journal of Medi- 
cine, the following very interesting case of Fracture of the 
Processus Dentatus, in which the patient continued to follow 
an active occupation for five months, and then suddenly died.] 

"On the 12th of August, 1852, while driving a 'fast horse' 
at the top of his speed on the plank road near Bushwick, L. I., 
he was thrown violently from his carriage by the wheel striking 
against the toll-gate. He alighted upon his head and face, 
about fifteen feet from the carriage. Upon rising to his feet 
he declared himself uninjured, but soon after complained of 
feeling faint: after drinking a glass of brandy, he felt better, 
got into his carriage with a friend, and drove home to Riving- 
ton-street, in this city, a distance of more than two miles. 
There was so little apparent danger in his case that no physi- 
cian was called that night. Early on the morning of the fol- 
lowing day, Dr. B. was called to visit him. He found his pa- 
tient reclining in his chair, in a restless state, and learned that 
he had suffered considerable pain in the back part of his head 
and neck during the night. He was entirely incapacitated to 
rotate the head, which led to the suspicion of some injury to 
the articulations of the upper cervical vertebrae ; but so great 
a degree of swelling existed about the neck, as to prevent an 

1853.] Fracture of the Processus Dentatas. 287 

efficient examination. There was no paralysis of any portion 
of the body, his pulse was about 90, and his general system 
but little disturbed. Warm fomentations were applied to the 
neck, and a mild cathartic administered. On the following 
day there was no particular change in his symptoms, but as 
there existed considerable nervous irritability, tinct. hyoscyami 
was prescribed as an anodyne, and fomentations of hops appli- 
ed locally. On the third day leeches were applied to the neck, 
and after this the swelling so much subsided, that on the fifth 
day an irregularity was discovered to exist in the region of the 
axis and atlas, which had many of the features of a partial lux- 
ation of these vertebras. 

" At this time he began to walk about the room, having pre- 
viously remained quiet on account of the pain he suffered on 
moving. He persisted in helping himself, and almost con- 
stantly supported his head with one hand applied to the occiput. 
He often remarked, if he could be relieved of the pain in his 
head and neck he should feel well. He began to relish his food, 
and the swelling nearly disappeared, at the end of a week, 
leaving a protuberance just below the base of the occiput, to 
the left of the central line of the spinal column, with a corres- 
ponding indentation. Notwithstanding strict orders to remain 
quietly at home, on the ninth day after the accident he rode out 
and in a day or two after returned as actively as ever to his 
former occupation of distributing milk throughout the city to 
his old customers. During the following four months no mate- 
rial change took place in his symptoms, although he constantly 
complained of pain in his head. For this period he did not 
omit a single day his round of duties as a milkman, which cccu- 
pied him constantly and actively from five o'clock in the mor- 
ning to nearly noon. On the 1st of November Prof. Watts 
examined him, and inclined to the opinion that there was a lux- 
ation of the upper cervical vertebrae. 

"About the 1st of January, 1853, the pains, from which he 
had been almost constantly a sufferer, became more severe, and 
he was heard to complain that he could not live in his present 
condition : he remarked also that he had heard a snapping in 
his neck. After going his daily round on the 11th of January, 
he complained of feeling cold, and afterwards of a numbness in 
his limbs. In the evening he had a chill and complained of pain 
in his bowels. He passed a restless night and arose on the 
following morning about six o'clock ; he was obliged to have 
assistance in dressing himself, and experienced a numbness of 
his left, and afterwards of his right side. He attempted to walk 
but could not without help, and it was observed that he drag- 
ged his feet. He sat down in a chair and almost instantly ex- 

288 Backward Dislocation of the Astragalus. [May, 

pired at eight o'clock a. m. on the 12th of January, precisely 
five months from the receipt of the injury. 

" The autopsy was made thirty hours after death, by Dr. C. 
E. Isaacs, in presence of several medical gentlemen. 

" Muscular development uncommonly fine ; an unusual 
prominence observed in the region of the axis and atlas. On 
making an incision from the occiput along the spines of the cer- 
vical vertebrae, the parts were found to be very vascular. These 
vertebrae were removed en masse, and a careful examination 
instituted. The transverse, the odontoid (ligamenta modera- 
toria,) as also all the ligaments of this region, excepting the oc- 
cipito-axoideum, were in a state of perfect integrity ; this latter 
was partially destroyed. A considerable amount of coagulated 
blood was found effused between the fractured surfaces, some 
of it apparently recent, but much of it was thought to have oc- 
curred at the time of the accident, and afterwards to have pre- 
vented the union of the bones. The spinal cord exhibited no 
appearances of any lesion. The odontoid process was found 
completely fractured off, and its lower extremity inclining back- 
wards toward the cord. Death finally took place, doubtless, 
from the displacement of the process, during some unfortunate 
movement of the head, by which pressure was made upon the 
cord. The destruction of the occipitoaxoid ligament, which 
would otherwise have protected the contents of the spinal cavity 
must have favored this result." 

Backward Dislocation of the Astragalus. 

[Prof. Alden March, of Albany, relates the following very 
interesting case, in " The Western Lancet." We give it a 
place in our Journal because of its exceedingly rare occur- 
rence :] 

"Isaac Quackenbush, of Herkimer, N. Y., aged about forty 
years, on the 24th of January 1853, while engaged in removing 
snow from the roof of his house, and elevated upon a ladder 
about ten feet whose base rested on the head of a hogshead, 
was suddenly precipitated to the ground ; and in his descent 
it was supposed his left foot struck with great force on the edge 
of the stoop, or step about eighteen inches from the ground. 

"The first impression after the fall that Mr. Q. experienced, 
was that he had broken his leg. 

" The fore part of the leg pointed a little downwards, having 
an unnatural fullness of the space below the internal malleolar 

1853.] Backward Dislocation of the Astragalus. 289 

process, and not only a fullness, but even a projection between 
the tendo achilles and the back part of the tibia, so much so, as 
to cause the tendon to be prominent and tense. The knee 
joint was sub-flexed, and the patient experienced more or less 
of a numb pain in the affected part, and running up the limb; 
and at times he complained of a burning heat in the bottom of 
the foot, and at other times as though it were in a freezing mix- 
ture ; and for most of two days it gave him great pain to extend 
the limb. The great toe was partially flexed, though suscep- 
tible of being extented by the hand without giving much pain. 

"This symptom, and that of the limb being more free from 
pain and more comfortable, when partially flexed, can be ex- 
plained, when we consider that the tendon of the flexor longus 
policis pedis, was carried out of its natural course upon the 
backward projecting astragalus, like a fiddle string elevated 
upon the bridge ; and that the displaced bone acted in some- 
what the same manner on the tendo achilles, when the limb 
was extended at the knee joint. 

"Dr. Doolittle, of Herkimer, N. Y., a very intelligent physi- 
cian, and of a great deal of experience, being the son of an 
aged physician of extensive practice, saw the patient twenty 
or thirty minutes after the occurence of the accident, when the 
character of it was readily detected, and an attempt made to 
reduce it. But he soon discovered, by its position, andunyiel- 
ded character, that all his efforts, and with all the means within 
his reach, would be unavailing. 

" The patient, accompanied by a young physician, was placed 
in a railroad car, and brought to Albany, on the evening of the 
accident with a view to procure my aid in reducing the disloca- 
tion. I left town the early part of the same evening, before the 
arrival of the patient, to be absent for a few days. 

;; The services of my colleagues, Doctors James H. Armsby 
and James McNaughton, gentlemen in every respect compe- 
tent by their anatomical knowledge and their experience and 
skill in the practice of surgery, were solicited; and with all the 
exertion in their power, both manual and mechanical, and con- 
tinued for a long time, failed to effect a reduction. 

" The patient returned to Herkimer where he was again 
placed under the care of Doctor Doolittle, who leeched the 
limb and put him on a thorough antiphlogistic course of treat- 
ment, which very much reduced the tumefaction and inflama- 
tion in the course of eight or ten days. 

"The State Medical Society commenced its annual session 
in this city on Tuesday the first inst., at which were assembled 
something like thirty five or forty of the most respeciable Phy- 
sicians and Surgeons of the State. 

290 Liquor Anunonice Acetatus. |_May, 

" It was deemed quite advisable that the patient should have 
the, benefit of the skill and wisdom of such an assemblage of 
medical men. Accordingly he was requested to visit Albany 
again, and although he did not arrive until after the adjourn- 
ment of the Society, consequently the case was not examined 
by its members, yet I had an opportunity to examine it most 
thoroughly on the evening of Thursday, ten days after the ac- 

" At this time, as I have already remarked, the inflammation 
and tumefaction had nearly subsided ; and on examination I 
found the foot admitted of a moderate degree of flexion and ex- 
tension, which was evidently between the os calcis and the as- 
tragalus, instead of between the tibia and astragalus. 

" The limb did not appear to be much deformed ; and my 
deliberate conviction was, that it would not be worth while to 
make any further attempt to reduce the displaced bone — and my 
prognosis, that the limb ultimately would become quite useful." 

Contributions calculated to enlighten us in relation to the 
action of remedial agents and to the best method of adminis- 
tering them are always acceptable. We therefore cheerfully 
give place to the following communication of Dr. John T. 
Plummer, contained in the " Western Lancet," on 
Liquor Ammonice Acetatis. 

" The following remarks may be of service, as items in the 
general stock of experience. They have been induced by the 
diversity of results, reported by different authors. Introduced 
more than a hundred years ago, its medicinal properties do not 
yet appear to be definitely settled, especially with regard to its 
action on the uterine functions ; and the doses to be adminis- 
tered. Cloquet of Paris, Mazuyer of Strasburg, and Pat-in of 
France, report favorably of its use in dysmenorrhea. The last 
named physician appears to have given 40 to 70 drops three or 
four times a day ; and by these doses giddiness was produced. 
Christison (Dispensatory) says 'the dose should be half an 
ounce for an adult every two or three hours ;' and makes no re- 
ference to its pathogenetic effects ; but adds, ' many physicians 
err in prescribing it in small doses.' Patin advises against the 
incautious use of it, as it diminishes the quantity of the menstru- 
al discharge. 'In large doses/ says Christison, 'it probably 
possesses the narcotic-irritant properties of other neutral am- 
moniacal salts. ' In cases of profuse catamenia and uterine 
hemorrhages, Patin obtained the most remarkable results. 

" For twenty years, I have employed this remedy with fre- 

1853.] Liquor Ammonice Acetatus. 291 

quent success in amenorrhea, instead of ' profuse catamenia ;' 
and in dvsmenorrhcea. I have prepared it extemporaneously, 
with strongest cider vinegar ; and with acetic acid of sp. gr. 
1011. The first I have generally used in amenorrhea, in half 
ounce doses every two hours, at the commencement of the men- 
strual efforts, indicated by headache, pains in the loins, &c; 
and in dvsmenorrhcea, in like manner. The preparation with 
acetic acid, I have used in the same affections, at intervals of 2 
to 4 hours. From the use of the vinegar combination, I have 
never witnessed the slightest ill effects, except, perhaps, some- 
times that degree of nausea which most medicines are apt to 
occasion. From the acetic acid preparation, I have observed 
variable effects in the doses named. 

"A married female, about 30 years old, suffered from a mul- 
titude of nervous symptoms, in consequence of a prolapsed 
uterus, occasioned by too early rising after confinement with 
her first, and as yet only child. To restore menstruation, she 
had taken, from various physicians, hellebore, savin, and nu- 
merous other articles, with but little effect. (The prolapsus 
appears not to have been suspected by her medical attendants.) 
After replacing the uterus, I found the catamenial period pain- 
ful, but without flow. I gave ]>ss doses of the aqueous acetate 
of ammonia, of the strength above named, and the menses ap- 
peared without any pathogenetic action from the medicine. 
At the next period, the same means were used, after the patient 
had been allowed to pass several days beyond the expected 
time ; and a more copious catamenia followed, than she had 
ever witnessed. 

" To another patient about 20, married, but sterile, yet pos- 
sessing general good health, I gavo 1 ss of the acetate, with the 
effect of vomiting, severe headache, and delirium. In a few 
hours the headache and delirium had ceased. Next day 3ij. 
of the acetate were given with the like result, but in less degree. 

"This article appears to have been proposed as a means of 
'dispelling intoxication.' In the last named case, it evidently 
induced symptoms, closely imitating intoxication, if it was not 
intoxication itself. 

" My experience fully accords with that of others, in respect 
to the febrifuge properties of this remedial agent. I have 
never been able to discover that it, in the slightest degree, ex- 
cites the sanguiferous system. So far from it, it has in my 
hands, appeared to be a cooling sedative. I have found it to 
be especially serviceable, in the early and eruptive stages of 
measels, sometimes combined with camphorated water, but 
mostly alone. 

" I do not wonder, however, that it has by some, been con- 

292 Quinine in Typhoid Fever. [May, 

sidered as a stimulant of the arterial function. Even as origi- 
nally prepared by Minderer, it appears to have differed from our 
modern solution, in being more disagreeable in consequence of 
the accidental formation of an ammoniacal soap. But as I have 
seen it formed extemporaneously by some, claiming to be phy- 
sicians and apothecaries, it would serve well, in case of emer- 
gency, to fill a smelling bottle. 

" I was called in consultation, in the case of a child laboring 
under dysenteric fever; and prescribed, in part, the solution of 
acet. of ammonia. In a few hours afterward, I w 7 as called, in 
the absence of the family physician, on account of the occur- 
rence of vomiting and increase of fever. Suspecting the cause, 
I examined the preparation, and found it so strongly ammonia- 
cal, that, to satisfy my curiosity, I took it home and added to 
one part of the original preparation, six parts of acid. acet. 
dilut., before the alkali became neutralized. At another house, 
in a case of infantile pneumonitis, I discovered a like prepara- 
tion to be the all-sufficient cause of a violent exacerbation of 
all the symptoms. I need not multiply examples ; the cases 
given, will serve to show, not only an inexcusable recklessness 
in the preparation of the medicine; but also, the premises from 
which some are willing to draw their conclusions of the proper- 
ties of remedial agents. To assure me that it was a neutral 
compound that he had been administering, the physician stated 
that he added the carbonate of ammonia until effervescence 
ceased. He may possibly have heard of litmus and termeric ; 
but according to his own avowal, the cessation of effervescence 
was enough for him, without the aid of these vegetable tell-tales. 

11 Of late years, I prepared this solution exclusively with di- 
lute acetic acid and the alkali. On account of the unsightly, 
turbid, brown liquid produced by the combination of ordinary 
vinegar with the ammonia; and the great variation in the 
strength of vinegar; dilute acetic acid of officinal specific grav- 
ity should always be used. When properly prepared, it re- 
quires much patience in attaining the point of neutralization, 
even with the aid of test papers. It may be readily kept for 
months, in a cool place, in well stopped vessels." 

On the Exhibition of large doses of Quinine as an abortive 
remedy in Typhoid Continued Fever. By Otis F. Manson, 
M. D., of North Carolina. 

" Principiis obsta ; sero medicina paratur 
Cum mala per longas convaluere moras." 

For the past nine years the writer of this paper has pursued 
a system of treatment unmentioned or condemned by the stand- 
ard authorities in practical medicine, and, until very recently, 

1853.] Quinine in Typhoid Fever. 293 

unknown on this continent, save in the extreme Southern 
States of our Union. 

At the risk of being unread, or of being attacked by over- 
whelming numbers — the great calamities of authorship — we 
pen this article : we do so, we fervently believe, not from any 
cacoethes scribenda, or desire for ephemeral notoriety, but from 
a conscientious desire to contribute to the cause of medical 
truth and medical progress. When we first came to this state, 
(1841), a fever, belonging to the periodical class, and exhibiting 
novel and peculiar phenomena, was then making its advent in 
the vicinity of our location. The usual treatment of the most 
skillful resident physicians most signally failed in arresting its 
progress, that treatment consisting in the employment of the 
usual role laid down in the books, viz: bleeding, general and 
topical, the mercurial impression, diaphoretics, opium, cathar- 
tics, and the various external revulsive and derivative irritants. 
General bleeding was soon abandoned by all, as it was quickly 
discovered to be hazardous in the extreme. Local bleeding 
only to a moderate extent was safely borne, the mercurial im- 
pression in the large majority of grave cases could not be timely 
effected ; and as in these cases intermissions or decided remis- 
sions very rarely occurred, guided as we then were by the 
precepts of the schools, quinine was but rarely given, and then 
only in small doses and with a trembling hand. This fever 
presented symptoms of abnormal sanguineous determination to 
the cephalic, thoracic and abdominal organs, either separately 
or combined, with the periodical occurrence of cold stages, in 
which the symptoms of organic engorgement and diminished 
circulation in the extreme parts were made more manifest: in 
a few words, the disease was a remittent fever, with marked 
hyperemia of some or all of the organs essential to life. 

In an essay published in 1846, we gave the symptoms and a 
brief outline of our treatment in this fever, the main feature of 
which consisted in the liberal employment of quinine without 
any hindrance to its use from the presence of local congestion, 
fever or inflammation. Not only was this treatment adopted 
in this but in every form of idiopathic fever, whether remittent 
or continued, which came under our care early in the attack, 
with the most satisfactory results. Since the year 1843, our 
general rule has been to endeavor to arrest these fevers during 
the first twenty-four hours the patient is seen — this rule sub- 
ject to restrictions hereinafter noticed. 

When we entered upon this practice we were opposed by 
nearly every member of our professional acquaintance, and by 
a host of others. Pictures of consequent insanity, apoplexy, 
phrenitis, paralysis and loss of the senses were held up to the 

n. s. — VOL. IX. no. v. 19 

294 Quinine in Typhoid Fever. [May, 

people to warn them against the innovation. In the midst of 
this clamor we visited Richmond for the purpose of publishing 
our views. We there met our ancient tutors and confreres : 
from all w T e received a kind and patient hearing, but with en- 
couragement from none. Some heard us in silence: many 
attempted to dissuade us from persisting in what they consid- 
ered " most hazardous practice." These obstacles only stimu- 
lated our ardor ; and we may have been intemperate in our 
zeal, but not, we hope, to such a degree as to justify the opin- 
ion of our friends, who hinted that we possessed the necessary 
qualifications to entitle us to an abode in those desirable asy- 
lums of Williamsburg and Staunton. But now (we hope we 
may be forgiven the taunt, the provocation was severe) they 
talk very learnedly of the abortive and sedative action of quin- 
ine, and have forgotten the name of him from the lips of whom 
they first heard it proclaimed. They have "stolen our thun- 
der," and we shall not forget them. 

Nothing daunted, however, by all these obstacles, we pursued 
our way. Every case of idiopathic fever (chiefly remittent 
and typhoid) in which the patient was seen near the accession 
of the disease, was immediately subjected to this treatment 
with the most signal success. The people, to whom the appeal 
was made — competent to judge of results, if not of means — 
pronounced in our favor beyond our most sanguine expecta- 
tions. In their train many of our opponents followed; but a 
f ew — we are glad, for the honor of the profession, they were 
but few — stoutly maintained " that the practice was nothing 
new to them — they had been pursuing it all along" and one 
oblivious old fogy, not to be outdone, dated his employment of 
the alkaloid at a period before its discovery. 

We mention these facts, in order that the date of our first 
employment of quinine in continued fever may be proven : the 
practice is original with us, so far as we have any knowledge. 
Others may have pursued it before; and if so, we will cheer- 
fully yield the merit of priority to those who can establish their 
claims thereto. 

Now we desire to be so plainly understood that misconcep- 
tion must be willful, viz: that we lay not a shadow of claim to 
the introduction of the use of quinine as a sedative febrifuge. 
It was used in this mode before we commenced our professional 
career. But to this we do lay claim : that we were the first 
to promulgate its applicability to the endemic fevers of Virginia 
and North Carolina, and the first anywhere, as far as our in- 
formation extends, who successfully employed it as an abortive 
remedy in continued fever — concerning which we now proceed 
more particularly to speak. 

1853.] Quinine in Typhoid Fever. 295 

For many years past, the usual varieties of periodical fever 
have been gradually yielding place to that mysterious, subtle, 
hitherto intractable, and often fatal form of continued fever, 
now almost universally termed typhoid. There is no need 
here of a description of the physiognomy or pathology of this 
malady. The distinguished Louis, the able and indefatigable 
Chomel, together with a host of others, have nothing left in 
these respects for the pen or scalpel to delineate, but we here 
lay our humble contribution before the Master Mind of him 
who is yet to indite the Unwritten Chapter of its Treatment. 

The practice pursued by us in this disease is in the highest 
degree rational, founded as it is upon the nature of the disease, 
so far as it is known, and on the effects of remedies proven by 
repeated and numberless experiments. 

Called to a patient in the first stage of the disease, our efforts 
are first direcled to combat the symptoms of morbid action, 
which, for convenience, we will term the palliative treatment; 
and secondly, to arrest, by specific means, the farther progress 
of the malady, the abortive or curative treatment. 

First : Palliative Treatment. — As, in other forms of fever, the 
symptoms presented will differ accordingly as different vital 
organs are implicated, the general rules of treatment will ne- 
cessarily be adopted. Our favorite plan, however, is to com- 
mence with the administration of an emetic of ipecacuanha, 
from which we have seen great benefit derived, not only from 
the removal of the contents of the stomach, for we have seen 
headach, lumbar pains, and, in a few cases, delirium, disappear 
under its influence. If the headache be intense or annoying, 
cups are applied to the mastoidal regions, whence blood flows 
profusely from clean scarifications; if delirium is present and 
the pulse will bear it, blood is taken from the arm to the extent 
of from 10 to 16 ounces, and ice freely applied. At 8 or 9 
o'clock at night a cathartic of calomel and rhubarb, in quanti- 
ties of 8 or 10 grains of each, is administered. If diarrhoea is 
present, a full dose of opium, of 1£ or 2 grs., is combined with 
the cathartic. Should there, however, be any fear of the rhu- 
barb not being tolerated, the calomel alone is given, in a dose 
of 15 to 20 grs. 

In the interval between the administration of the purgative 
and 2 o'clock next morning every means are used to relieve 
the threatened organs. Cups are continued to the occiput or 
epigastrium, as may be indicated; cold applications to the 
head assiduously applied, and all proper means used to prepare 
the patient for the 

Curative or Abortive Treatment. At 2 o'clock in the morn- 
ing from 20 to 30 grs. of sulphate of quinine in pills, or diffused 

296 Quinine in Typhoid Fever. [May, 

in an ounce of cold water, are given at once to the patient, the 
dose being: regulated according to the intensity of the fever, 
the quantity being increased pari passu with the degree of vas- 
cular excitement. Four hours are now suffered to elapse ; the 
patient is allowed to drink moderately of diluents, of which, at 
this moment, we prefer sweetened milk and water pleasantly 
warm, or the effervescing draught. The condition of the 
patient at the end of four hours, viz: at 6 o'clock, in a vast 
majority of cases, will be sensibly improved ; his head symptoms 
will be partially or entirely removed ; his pulse will be dimin- 
ished in frequency and force, and have acquired a more natural 
degree of fullness and softness; his skin will have become re- 
laxed and perspirable, and in many instances a copious sweat 
breaks out, and, as the patient has often expressed himself to 
us, " He feels like a new man ; his head is easy for the first 
time since he has been sick!" At 6 o'clock, (unless there be 
marked symptoms of quininism — deafness, roaring, buzzing, 
hissing, ringing of the ears — present,) if the pulse has not de- 
clined very nearly to the normal standard, it is our rule to repeat 
the quinine in doses of 10 to 20 grs. During the night the cold 
applications and local bleeding are continued, if indicated, but 
it is very rarely we have to repeat the cupping after the quin- 
ine is given. Ice in most cases will suffice. 

The quinine is now suspended, if fever still continues. Calo- 
mel is administered in 1 or 2 gr. doses every one or two hours, 
until the bowels are sufficiently moved. If diarrhoea is present, 
the hyd. cum creta and Dover's powders are preferable. If 
fever still continues, at 2 o'clock next morning the quinine is 
again given, the dose to be lessened accordingly as the fever 
has declined, and the alterative continued. Attention is now 
directed to the symptoms present — for which no specific rules 
can be given, for here the general principles of treatment are 
brought into requisition — the patient is carefully conducted 
towards convalescence, and the wants of nature supplied. As 
the fever disappears the diet must be increased, and wine and 
tonics, of which we prefer gentian, will be useful, and often 

If, however, the fever persists, as it sometimes will, but always 
in a mild and modified form, the oil of turpentine, a remedy 
long used, but more particularly called to the attention of the 
profession by Prof. Wood, now comes admirably into use. 
From 20 to 30 drops in a wineglassful of sweet milk, or in 
emulsion, may be given every four or five hours. This, how- 
ever, will sometimes give rise to unpleasant and even dan- 
gerous symptoms, viz: a peculiar intoxication, gastrodynia, 
haematuria and dysuria, when of course it will be discontinued. 

1853.] Quinine in Typhoid Fever, 297 

After this treatment is pursued, it is but seldom that we give 
any aperient medicine: officious meddling in this respect, we 
have no doubt, has had a principal share in the mortality of 
typhoid fever. Mucillaginous enemata are daily used, and a 
simple remedy, that will often succeed when repeated enemata 
fail, is a suppository of stewed molasses. 

Observations on the foregoing Treatment. 

The practitioner must not be deterred from the use of the 
mercurial cathartic in the first instance, though diarrhoea be 
present ; for if the opium does not control its action, the quin- 
ine, often administered, certainly will, and in such cases we 
have never seen hypercatharsis induced — quinine possessing 


Neither should nausea or vomiting be considered as indica- 
tions adverse to the employment of this remedy : on the con- 
trary, if the stomach will bear its mechanical presence for a 
short time, it will allay these troublesome symptoms when all 
other means fail. It produces these effects by its property 


Nor should delirium be considered a contra-indication. Af- 
ter using the means before directed, with all the activity and 
energy the case demands and the patient will safely bear, the 
delirium will still continue in some instances. In such cases 
we have repeatedly seen every symptom of cerebral implica- 
tion removed as if by magic, under the influence of this incom- 
parable sedative. It is our rule to try the usual means^r^; 
we believe them to be necessary and efficient adjuvants to the 
salutary influence of the abortive: they prepare the way and 
assist the remedy in producing its complete and peculiar influ- 
ence : the exhibition of quinine does not interfere in any degree 
with the demands of the rational indications, but it is given for 
the purpose of assisting their action, and rendering their effects 
complete and permanent. 

The usual treatment of the best authors of the present day 
is merely expectant and palliative ; their whole endeavor is to 
ameliorate the condition of vital organs, and to remove the 
secondary phenomena: on the other hand, quinine strikes tri- 
umphantly at the roots of the malady and removes the cause. 

But the reason may be demanded of us, "Why we do not 
use this remedy in the latter as well as the primary stage?'' 
We reply — Because our experience is against its use. Believ- 
ing, as we do, that the symptoms of the prodromic and invasive 
stages are altogether referable to an altered and perverted ac- 

298 Collodion in the Treatment of Buboes. [May, 

tion of the nervous system, and knowing that quinine possesses 
the property of counteracting the morbid action then present 
we unhesitatingly and boldly prescribe it ; but soon another 
class of symptoms present themselves — symptoms referable to 
and indicative of organic change — those lesions so minutely 
and accurately portrayed by the most celebrated pathologists 
of the age, and which we believe that quinine has no power to 
remove but may often aggravate. These cases must be treated 
according to the rational indications. Active interference, our 
experience has proven, is no longer admissible ; with watchful 
eye and careful hand we must discern and assist the operations 
of nature, endeavoring to mitigate and remove the symptoms 
of distress, discomfort and danger, and guarding closely the 
approaches through which the destroyer may enter at any 
moment. — [Stethoscope. 

Collodion in the Treatment of Buboes. By Jno. Herbert 
Claiborne, M. D., of Petersburg, Va. 

The obstinacy that buboes sometimes assume, pertinaciously 
refusing either to suppurate or to be discussed, often proves 
exceedingly annoying to the patient, if it does not indeed occa- 
sionally bring reproach upon the efficacy of medical treatment. 
Few physicians, I imagine, who have had the treatment of 
many of these troublesome affections, have not seen the patience 
of their patients grow weary under their unavailing efforts to 
scatter a chronic bubo in the groin ; and fortunate may they 
consider themselves if they have not been compelled to listen 
to imprecations upon their art for its worthlessness and ineffi- 
cacy, Since I have begun the use of collodion in such cases, 
I am glad to remember that I have been almost entirely exempt 
from listening to tirades from the subjects of this malady at 

I use the collodion solely for the purpose of discussing or 
scattering the bubo, and in my hands it has proved incompara- 
bly superior to any other discutient. It operates by pressure, 
I believe, thereby lessening the capillary congestion of the 
parts, and stimulating the absorbents to remove whatever pro- 
ducts may have been thrown out by inflammation about or in 
the affected glands. 

I have used it in the treatment of buboes of the groin only. 
When a patient with a bubo presents himself, if there be not 
much acute local inflammation, no matter formed, and no con- 
stitutional reaction, I immediately shave off the capilli from 
and around the tumor, and with a camel's hair pencil apply 

1853.] Collodion in the Treatment of Buboes. 299 

the collodion upon the place, allowing one layer to dry before 
the application of another, until I form a scab or membrane of 
such thickness as I think will exert the proper compression. 
Sometimes the application has to be renewed in the course of 
twenty-four or forty eight hours. If put on too thickly, it will 
give a great deal of pain ; and I have seen it contract so tight- 
ly upon the tumor, that the epidermis would be split in fissures 
around the borders of the application. This will serve to give 
some idea of the force cf the compression which it will exert. 
After the application of the collodion, it is better that the pa- 
tient remain quiet for a day or two, take an aperient, and re- 
strict his diet, though I have succeeded in discussing a chronic 
bubo when not an hour has been lost from his usual avocations. 

If there be much inflammation about the tumor, I usually 
endeavor to subdue this by general and local depletion, satur- 
nine applications, rest, &c, before applying the collodion; and 
if the bubo be of venereal origin, institute, of course, the specific 
treatment for the existing disease. 

I have succeeded several times in discussing the bubo in this 
manner, even when fluctuation discovered the presence of 
matter. If it be of syphilitic origin, however, I doubt very 
much the propriety of this. The dissipation of the tumor, in 
this instance,. can only occur by a reabsorption of the virus of 
the pox into the blood, whereas the sole object of the treatment 
of syphilis is to eliminate this poison. In such cases, therefore, 
I prefer puncturing the bubo at the earliest indication of mat- 
ter, and encouraging suppuration by poultices. 

I have several cases in my note-book which strikingly ex- 
emplify the efficacy of collodion in the discussion of buboes. I 
suppose it might be usefully employed in chronic enlargements 
of glands in other portions of the body. I do not know that I 
can lay claim to the honor of originating this application of 
collodion, if there be honor in it; but I do not remember to 
have seen it spoken of by any medical author. If any one shall 
rise up and claim it, I am ready to yield unto him "the things 
which are his." The principle of scattering buboes by the ap- 
plication of pressure was first remarked by me in following 
one of the surgical officers in the wards of the Pennsylvania 
hospital some few years ago. In that institution they were in 
the habit of making pressure by fastening on plates of sheet 
lead. In the inconvenience of applying these, and in some ex- 
tremely obstinate and annoying cases, which greatly perplexed 
me, I thought of substituting the collodion. The success which 
attended it exceeded my expectations. 

Perhaps some of my professional brethren have used it — I 
would like to know with what success. — [Ibid. 

300 The Alum Springs of Virginia. [May, 

The Alum Springs of Virginia. 

Having for some lime heard of and entertained a favorable 
opinion of the Alum Springs of Virginia in the treatment of 
certain affections, we are happy to have it in our power to lay 
before our readers some account of them. We derive the fol- 
lowing facts from an article by Dr. Thomas Pollard, published 
in the " Stethoscope. " 

The Rockbridge Alum Springs are situated seventeen miles 
from Lexington. The water of Spring No. 2, was analyzed 
by Dr. Hays, of Boston, one gallon of which was found to 
contain — 

Sulphate of potash, 


" lime, - 


" " magnesia, - 


Protoxide iron, 



- 17.905 

Crenate of ammonia, 


Chloride sodium, - 


Silicic acid, 


Free sulphuric acid, 

- 15.224 

Free carbonic acid, 



Pure water 


" In a conversation with the late proprietors* of this property, 
they informed me that they did not consider the analysis as 
made from a fair sample of the water ; that the water was pro- 
bably weak at the time, and No. 2, in their estimation, not so 
good as the other springs, and that they believed them to con- 
tain iodine. Dr. P. H. Christian, one of the proprietors at the 
time referred to, informed me that Prof. Rogers had made an 
analysis of the water, which had never been published, and that 
he understood that Prof. R. found it to contain iodine. 

" Therapeutic Application. — The diseases in which this wa- 
ter has most reputation, are dyspepsia, scrofula, chronic diar- 
rhoea and skin diseases. The time has gone by for skepticism 
in relation to the medicinal virtues of mineral waters. I can 
only give a general outline of the cases to which I shall allude, 
as some of them did not come directly under my observation 

* It had at this time been purchased by Mr. John W. Frazier of the Bath 
Alum, though he had not obtained possession. 

1853.] The Alum Springs of Virginia. 301 

nnd others I have no permission to make a formal report of. 
That some undoubted cases of scrofula have been relieved by 
the water of which we are speaking, does not admit of a doubt. 
Several such cases I have seen, and of others heard from relia- 
ble authority. Dr. Christian, who has had considerable oppor- 
tunity of observing its effects, remarked to me that he believed 
every case of scrofula, where the constitution was not utterly 
broken down, might, if the water were long enough continued, 
be cured. We can scarcely hope it, however, to be a specific 
in this disease. Two cases which at the springs came under 
my notice, where after two months' use in one case and one 
month in the other, no perceptible benefit had been perceived 
except most decided improvement in the general health. Pro- 
bably the foundation of cure was thus laid, and another summer 
at the springs, with use of the water in the intermediate time, 
may effect the desired object. I allude to these cases as being 
the only unfavorable ones I saw or heard of among those suf- 
fering from scrofula. One case of most marked improvement 
I may allude to as being no doubt familiar to some of the facul- 
ty of this city : Mrs. S., of Rocketts, suffering from a large 
scrofulous sore on the side of the neck. She had used the wa- 
ter four or five weeks, and from her representation the amend- 
ment had been rapid. While I saw her, which was during the 
space of two weeks, the sore was every day diminishing in 
size and assuming a more healthy appearance, and there seem- 
ed every prospect of perfect cure. Closely allied to the disease 
of which we are speaking, were two cases reported to me as 
having been cured by the persons who were the subjects of 
them, and as far as an opinion may be formed from two cases, 
of course imperfectly described, the use of this water in incipi- 
ent phthisis would seem very encouraging. One case, a ser- 
vant who waited on the hotel, had been sent by his master to 
use the water for haemoptysis, of which he had had several 
attacks, and from which his general health had suffered much. 
The haemoptysis was attended with pain in the side, and the 
lung of that side had been pronounced diseased by his attend- 
ing physician. When I saw him his general health was good, 
and as far as I could judge, he seemed a well man. The other, 
a white man, resident in the neighborhood, told me he had had 
several attacks of haemoptysis, with constant pain in the side, 
while residing in Georgia. Superadded to this was a running 
scrofulous sore about the neck. The sore had healed ; no 
haemoptysis had occurred for many months, and to all appear- 
ances he was well. 

"In dyspepsia this water seems to act with excellent effect. 
Almost every case of this disease which has come under my 

302 The Alum Springs of Virginia. [May 

observation, in which the water has been used both at the 
springs and after transportation, has been much benefitted. In 
chronic diarrhoea, and in cases of dyspepsia attended with irri- 
tability of the bowels, its action is usually very advantageous. 
In such cases the quantity used, however, should not be large, 
and when it excites any irritation, as it sometimes does, should, 
for a day or two, be suspended. 

"In skin diseases its virtues are said to be very valuable. I 
had no opportunity of judging of its effects in this class of dis- 
eases, except in one case of chronic erysipelas of the leg, which 
was rapidly improving. 

" In one case of chronic sore throat, which came under my 
notice, the effect of the water was most salutary. The subject 
of it, a gentleman from Philadelphia, had suffered from ulcera- 
tion about the fauces and tonsils for several months. Caustics 
of various kinds had been used by a medical gentleman of emi- 
nence, and no doubt with skill and judgment. He had visited 
the White Sulphur Springs without benefit, and came to the 
Rockbridge Alum still suffering a good deal, particularly in 
swallowing. After spending five days here, at which time I 
saw him, the improvement had been most marked — difficulty 
and pain in deglutition had ceased ; the ulcers, of which there 
had been several, were healing, and in two weeks his throat, to 
use his expression, 'felt well.' At this time the ulcers had all 
healed, with the exception of a long fissured one, which was 

" Modus operandi. — From the existence of sulph. alumina in 
this water, we might expect that constipation would be pro- 
duced by its use. Such, however, is not the fact. The bowels 
seem regulated. If constipation exists, it is removed. If chronic 
diarrhoea, it is generally cured. This may appear contradic- 
tory, but is not incompatible with the known action of other 
remedies. In some cases, wl.en long continued, the water 
seems to irritate the bowels — the effect probably of the iron. 
The presence of the sulph. alumina furnishes a valuable adju- 
vant in preventing, in general, this irritant effect of the iron, 
of which we have frequently to complain in the use of our 
medicinal preparations of this metal. 

" The quantity to be used. — This, of course, will depend upon 
the strength, which, as I have mentioned, varies considerably. 
When the water is at its strongest, a tumblerful will frequently 
produce emesis, owing, 1 suppose, to the existence of the iron 
and alumina. As a general rule, six glassesful during the day 
is enough for most individuals: tin's should not be taken when 
the stomach is full. Too much of this water is frequently drunk, 
overloading and oppressing the stomach, and this remark we 
believe will apply generally to the use of mineral waters." 

1853.] The Alum Springs of Virginia. 

The Bath Alum Springs are seventeen miles from the Rock- 
spring — and, on Analysis by the same chemist, yield from one 
gallon : 

' Free sulphuric acid, 


Carbonic acid, 


Sulphate of potash, 






Protoxide of iron, 




Crenate of ammonia, - 


Silicate of soda, 



Pure water, 

- 58317.202 

"Some of the springs are stronger in iron than No. 3, and no 
doubt constitute the strongest chalybeate waters in the State. 
The water of No. 3 is most generally used. The iron and 
alumina are no doubt in the form of the sulphates, both in this 
water and in that of the Rockbridge Alum springs. It is so given 
by Prof. Rogers, as reported in Dr. Burke's book, p. 295. 

" Therapeutic application. — The diseases in which this water 
is used are very similar to those in which the Rockbridge Alum 
springs are applied. Containing more iron, they are more 
strongly tonic, and are more adapted to some forms of dyspep- 
sia, chlorosis and affections generally requiring an active tonic 
impression. Dr. Burke, in his work on the Virginia Springs, 
quotes a letter from Dr. Strother of the Warm springs, speak- 
ing highly of their virtues, and recommending them as valuable 
in chronic diarrhoea, chronic thrush, dyspepsia, nervous debili- 
ty and some forms of neuralgia, uterine disorders, particularly 
mennorrhagia and fluor albus. The water of these springs has 
not had a fair trial, a prejudice existing against it from the fact 
that the public are apprised, from their strong metallic taste, 
that they contain copperas, which, not knowing that it is one 
of our best tonics, (sulph. iron,) they mistakenly believe to be 

" This water being very strong, a tumblerful (a quantity 
which many persons ignorantly use) produces emesis. This 
confirms the impression of the 'poisonous copperas,' and they 
cannot be persuaded to make further trial of it. The conse- 
quence is, the water has been used to a limited extent. My 
own impression of its value is, that when these springs become 

304 On Reflex Phenomena. [.May, 

better known, and the water more properly used, it will rank 
as one of the most valuable of our mineral waters. Though 
these springs have been in use only three or four years, I have 
been informed, through reliable sources, of the cure of three 
cases of scrofula. Two cases of chronic diarrhoea which came 
under my notice, were much benefited. Another case improv- 
ed but slightly, but I thought it was because the gentleman used 
the water in too large quantities. 

" Quantity to be used. — Four tumblersful are generally 
enough to be taken during the day. In some cases, and parti- 
cularly in chronic diarrhoea, one wineglassful. repeated five or 
six times a day, is as much as should be used." 

On Reflex Phenomena. By M. CI. Bernard. 

Reflex Phenomena are of two kinds: the one having for ob- 
ject the accomplishment of the functions of organic life, the 
other those of animal life. M. Bernard has by his experiments 
endeavored to show that both of these phenomena are original- 
ly identical, and that the great sympathetic nerve plays a prom- 
inent part in their production. He first examined the reflex 
phenomena of organic life. 

Two kinds of nerves are requisite for the production of these 
phenomena: the first transmiis the impression to the nervous 
centres, the second to the viscera. With one order of these 
nervous filaments is always connected a ganglion of the great 
sympathetic ; exemple : the lingual nerve transmits the impres- 
sion of taste to the nervous centres, a special nerve then con- 
veys a corresponding excitation to the submaxilary gland ; on 
one of these nerves is situated a ganglion of the sympathetic, the 
submaxilary ganglion. — Another example : the optic nerve and 
the motores oculorum, the first transmitting the impression, 
the second the reflex excitation, are separated by the opthalmic 
ganglion. The pneumogastric nerve may be considered in the 
same light in its relations with the liver, lungs, and spinal mar- 
row ; the last is here a conductor of reflex excitation, and the 
ganglia of the solar and cardiac plexuses play the same part as 
that which has been assigned in the preceding examples to 
those of the submaxilary and opthalmic regions. 

Excite the lingual nerve, and the secretion of salva will be 
increased ; cut the submaxilarly ganglion, the nerve which con- 
nects it with the nervous centre, and the excitation of the lin- 
gual nerve will no longer produce this phenomenon. The ex- 
periments of Herbert Mayo prove that in the movements of 
the pupil, the results are identical as regards the optic nerve and 
the motores oculorum. 

1853.] On Reflex Phenomena. 305 

The pneumograstric nerve is the seat of analogous phenome- 
na ; as example : this nerve transmits to the nervous centre the 
impression made upon the lungs by atmospheric air, their 
habitual excitant; this impression, b\ means of the spinal mar- 
row and sympathetic, immediately causes the production of 
sugar in the liver, which secretion, the result of reflex action, 
corresponds to the excitation of which the lungs are the seat, 
just as the secretion of saliva is the result of an irritation of the 
lingual nerve. Excite the lingual nerve and the secretion of 
saliva will be exaggerated; excite the lungs by means of chlo- 
roform or chlorine and the secretion of sugar in the liver will 
be increased. From these considerations, M. Bernard is led 
to attribute the exaggerated production of sugar in the liver, 
caused by irritation of the pneumogastric nerve, to the reflex 
phenomena of organic life. 

After having called the attention of the society to the impor- 
tant function which is performed by the great sympathetic 
in the production of visceral reflex phenomena, M. Bernard 
asks if the reflex phenomena of the limbs have not, even in 
this last point of view, a great analogy with the preceding ; it 
seems at the first glance that such is not the case, for in the ex- 
periments of Marshal Hall, the ganglia do not appear to have 
any relation w r ith the production of reflex movements. The 
following experiment, however, imagined by M. Bernard, 
seems to show that the intervertebral ganglia cannot be wound- 
ed without a corresponding cessation of reflex movement in 
the limbs. By a singular disposition the roots of the nerves of 
the anterior members in the frog, are seen, on dividing succes- 
sively the muscles of the shoulder, to the outside of the medula- 
ry canal ; the posterior provided with their proper glanglia. If 
these be examined attentively it will be observed that all the 
nervous filaments of the posterior root, do not traverse the gang- 
lia, and that a certain number of them may be easily isolated by 
the point of a needle. From this anatomical arrangement it 
results that the ganglia may be destroyed and still a portion of 
the posterior root remain intact. Now if the section of the gan- 
glia in the living frog be completed, reflex action ceases in the 
corresponding member ; the animal no longer withdraws its 
foot on its being irritated ; that sensibility, however, remains 
perfect, is proven by the fact that the animal manifests signs of 
pain by movements of the whole body. This experiment shows 
then, that the intervertebral ganglia are necessary to the pro- 
duction of reflex movements in the limbs. Lead by analogy, 
M. Bernard concludes, in assimilating the intervertebral gan- 
glia with those of the great sympathetic, that they are both ne- 
cessary in the production of the two order of reflex phenomena 
admitted by him. — [Gazette Medicale. N. O. Med. Register. 

306 On Hemorrhage. [May, 

On Hemorrhage. On a new Styptic. By M. Pagliari. 

This styptic forms a subject of a long communication to the 
Academie des Sciences by C. Sedillot. Its composition is as 
follows : eight ounces of balsam of benzoin, one pound of sul- 
phate of alumina and potass, and ten pounds of common water 
are boiled for six hours in a glazed earthen vessel, care being 
taken to add fresh quantities of boiling water, so as to supply the 
loss in evaporation, and to stir continually. At the end of this 
time the supernatant liquid is separated from the undissolved 
benzoin, which has lost its odor and inflammability, and filtered 
and preserved in glass bottle's. The liquid thus obtained is 
limpid, and of the color of champagne ; its taste slightly stypic, 
and its odor pleasant and aromatic, and when evaporated it 
leaves a transparent deposit on the sides of the vessel. 

The styptic properties of this preparation seem very remark- 
able. A single drop immediately coagulates a cupping-glass 
ful of blood, and a larger quantity (equal proportions) converts 
the blood into a firm and resisting solid. Applied to a wound 
the hemorrhage ceases almost immediately, in consequence, as 
it would seem, of the formation of such clots upon all the orifices 
of the bleeding vessels. The application also produces no irri- 
tation and inconvenience, nor does it interfere in any way with 
the process of cicatrisation. 

The cases given are well authenticated, and the results such 
as to leave no doubt as to the valuable styptic properties of the 
preparation. There are cases of obstinate primary and secon- 
dary hemorrhages, after supgical operations ; one from a severe 
cut in the finger; some from the extraction of a tooth. In 
these cases a piece of lint was soaked in the styptic and bound 
upon the wound. — [lb. 

The Laws regulating the Bodily Temperature and the Frequen- 
cy of the Pulse. By R. Lichtenfels andR. Frohlich. 

The authors have made a most careful series of experiments 
on themselves. Each experimenter is twenty -two years of age ; 
the pulse of one of them is normally 71 per minute, that of the 
other 88 ; the normal temperature of each is 98.434. During 
the course of the experiments, they rose shortly before 7 A. M., 
took coffee between 7 and 8, had dinner at 2, and evening-cof- 
fee between 7 and 8. 

1. Daily rate of pulse and temperature. — The influence of 
the period of the day, per se*, was very trifling, but both pulse 
and temperature were greatly affected by food. Before the 
morning-coffee, the pulse was lowest ; by the end of the first 

1853.] Laws regulating Bodily Temperature, fyc. 307 

hour after coffee it rose, on an average of many observations, 
nearly 8 beats per minute ; it was slightly less rapid at the end 
of the next hour; at the end of the third hour it was only 3.3 
beats ; and at the end of the fourth, 2.77 beats over the original 
number. The pulse did not sink to the number noted before 
coffee, till six hours had elapsed. The mid-day meal raised the 
pulse again, and this occurred apparently sooner after protein 
than after starchy food, but to a less extent. After the evening- 
coffee, the pulse, which had fallen, again rose, but to a less ex- 
tent, and its declension occurred more rapidly. 

The temperature of the body was affected in a similar way 
by food, but the augmentation occurred later than the rising of 
the pulse; so that the temperature was often at its maximum 
when the pulse had fallen considerably towards the point from 
which it had risen. The average amount of increase is about 
I of Fah. The greatest average range of the thermometer in 
the course of the day (between 7 A. Si. and 10 P. M.) was ra- 
ther less than a degree of Fah. 

2. Influence of customarxj liquid. — The experiments were 
performed in the afternoon ; each lasted 100 minutes, and the 
greatest tranquility of body was preserved. After beer, the 
pulse sank 6 or 7 beats in from 10 to 15 minutes; in 30 minutes 
it regained its former frequency ; much before this time, the 
subjective feelings of slight incipient intoxication were felt. 
In about two hours, the pulse was heightened nearly double 
as much as it had been depressed. The temperature, after the 
use of beer, fell about one-third of a degree of Fah. After wine, 
the pulse at first fell in the same way, and then rose greatly ; 
the temperature fell about half a degree of Fah. The same 
occurred with alcohol, but afterwards the temperature rose 
about a quarter or half a degrea of Fah. Cold water lessened, 
at first, the number of the pulse, and lowered the temperature. 
In 15 minutes both returned to their former amount. Coffee, 
as already said, raised the pulse, but more in the morning than 
in the evening. 

3. Influence of fasting. — Fasting for from 20 to 21 hours 
lowered both pulse and temperature. At the end, the pulse 
was from 12 to 16 per minute; the temperature as much as 
1.8° Fah., under the normal. The curious observation (made 
also by Davy and Gierse) was noted, that at the period of cus- 
tomary meal-times both pulse and temperature slightly rose. 

4. Influence of muscular movements. — Various experiments 
were tried with different kinds of movements. 1. A ten pound 
weight was allowed to hang from the arm for five minutes, the 
body being tranquil ; the pulse first fell in frequency, then rose; 
its greatest frequency was after the termination of the experi- 

308 Ash-tree leaves in Gout and Rheumatism. [May, 

ment. When the weight was on the left arm, the rise was 
nearly double that which occurred when it was on the right 
arm. 2. A weight of one pound was held out horizontally ; 
the pulse rose and fell remarkably several times. 3. A weight 
of two pounds was rapidly swung round and round with one 
one arm, while the other was placed on a table, that the pulse 
might be counted. This exercise produced the greatest effect 
on the pulse, raising it sometimes from 30 to 50 beats. 4. 
Long-continued moderate exercise, carried on to fatigue, raised 
the pulse greatly for some considerable time, but never pro- 
duced the enormous rise noted in the previous kind (3) of mus- 
cular exertion. 

5. Influence of narcotic poisons. — Belladonna and atropine 
at first diminished the frequency of the pulse (16 to 20 beats), 
but after a variable time (50 to 117 minutes) the pulse again 
rose (12 to 30 beats). The smaller doses produced greater 
primary sinking than the large, but required much longer time 
to do so; on the contrary, the larger doses produced much 
greater secondary rising; that is to say, the maximum sinking 
point is inversely, and the maximum rising point is directly, 
proportioned to the amount of the drug. It might be said that 
small doses depress, larger excite, the pulse. The temperature 
was diminished in all cases. Opium, especially in small doses, 
caused rising of the pulse, but afterwards there was great sink- 
ing, and the temperature diminished. The Cannabis Indica 
produced many periods of rising and falling; the temperature 
rose for about four hours, and to as great a degree as .7° or 1° 
Fah. Chloroform and ether, if not pushed to too deep a nar- 
cotism, raised both temperature and pulse. — [British and For. 
Medico- Chirurgical Review. 

Infusion of the leaves of the Ash-tree (Fraxinus polygamic) 
in the treatment of Gout and Rheumatism. By Drs. Pouget 
and Peyraud. 

The most useful acquisitions in materia medica are due gen- 
erally to chance, or, rather, to a protective Providence over 
human health; e. g., the antiperiodic properties of cinchona. 

In 1842, Dr. Peyraud experienced his first attack of gout, 
for which he employed the usual remedies. The attack lasted 
twenty-five days. During the three following years the diseae 
increased both in frequency and violence, and the patient went 
through the several forms of treatment without finding relief. 
He heard, by accident, that the infusion of the ash-leaves had 
long been considered a specific in the department of Dordogne, 
and that the peasantry of the district used it to "chase away 

1853.] Adulteration of Sulphate of Quinine. 309 

their pains." Dr. Peyraud found it upon trial so useful that he 
had but one attack of the gout from 1845 to J849. 

M. B., a merchant of Bordeaux, was seized with an attack of 
gout, for the first time, in the right foot. He was ordered 
infusion of ash-leaves ; upon the second day he was able to 
come down stairs and to leave his house. Ever since, he has 
had recourse to the same remedy with good effect upon expe- 
riencing premonitory symptoms, such as headache, loss of ap- 
petite, etc. The same success followed its administration in 
cases of acute articular rheumatism. A house-painter, aged 
23, had, upon several occasions, suffered from acute articular 
rheumatism, accompanied by endocarditis, which prevented 
his following his occupation for four months or more. Decem- 
ber 25, 1849, he had pain in the articulations of the feet, knees, 
and wrists, with swelling, accompanied by difficulty of respi- 
ration and inability to lie down. December 30, he was so 
weak that it was thought better, before bleeding him, to try 
the infusion of ash-leaves. In about twelve hours, and after 
the third dose, the patient was able to breathe easier, and there 
were fewer periodical pains. On the fourth day, the articular 
pains had diminished in intensity, the respiration was freer, and 
•the appetite had returned. Jauuary 22d. — He was able to re- 
sume work. The authors now administer it in the form of a 
fine powder in preference to the infusion. Other cases are 
related in the Essay. — [London Med. Times. 

On Adulteration of Sulphate of Quinine. By Dr. Moll. 

The excessive price of the true cinchona, the calisava of 
Bolivia, has led to the substitution of many inferior kinds, 
chiefly remarkable for their containing large proportions of 
quinidine. In consequence of their lower price they have ob- 
tained admission to the quinine manufactories in large quanti- 
ties, and much of the sulphate now produced is depreciated by 
the addition of quinidine. This substance differs from the 
sulphate of quinine by its greater specific gravity and less floc- 
culent crystallization, and it is much more soluble than it is in 
water and alcohol. The addition of both cinchonine and quini- 
dine may be detected by means of ether ; for while cinchonine 
is almost insoluble in this substance, quinidine is so in a far less 
degree than is quinine, inasmuch as sixty drops of ether and 
twenty of ammonia will dissolve ten grains of quinine and only 
one prrain of quinidine. On the addition of these quantities of 
sulphuric ether and liq. ammonia, to ten grains of quinine, with 
ten drops of dilute sulphuric acid, and fifteen of water, all will 

n. s. — vol. ix. no. v. 20 

310 Reproduction of Nervous Substance, fyc. [May, 

remain dissolved, unless cinchonine, or more than ten per cent, 
ofquinidine be present, the mechanical impurities only appear- 
ing at the surface. If 10 per cent, ofquinidine be present in 
the ethereal solution, it will soon crystallize on the surface of 
the ether. Traces Of this substance can be yet more certainly 
discovered if ether saturated with quinidine be employed, when 
all that exists in the suspected salt will remain insoluble. If 
the powder contain cinchonine, or more than 10 per cent, 
quinidine, it will remain undissolved at the line of demarkation 
of the two fluids. If it be quinidine, it is soluble in additional 
ether, which cinchonine is not. 

To establish the purity of quinine, we must also assure our- 
selves of the absence of inorganic substances, by calcination 
in platina, or by a solution of the salt in alcohol. Sulphate 
and carbonate of lime, magnesia, &c, remain undissolved, 
while boracic acid, though soluble, betrays itself by its blue 
flame on conflagration. The absence of organic substances, 
as salicine, sugar, starch, stearic acid, is known by the color- 
less solution which takes place in concentrated sulphuric acid. 
The presence of ammoniacal salts is revealed by the odor which 
ensues on the addition of caustic alkali. — [Brit, and For. Med. 
Chir. Rev.,foom Rev. Medic o-Chirurg . 

On the Reproduction of Nervous Substance, and on the Struc- 
ture and Functions of the Spinal Ganglia. By Dr. A, 

Dr. Waller, after having made many experiments on differ- 
ent animals, principally warm blooded ones, of an early age, 
and frogs, considers himself entitled to the conclusion: ''That 
the old fibres of a divided nerve never gain anew their original 
structure and function, and that the reproduction of nervous 
substance does not take place merely in the cicatrixjtself, but 
also downwards into the terminating ramifications. The old 
fibres gradually waste, and after a month or later, new fibres 
are formed, which are pale and transparent, possess no double 
contour, present a very unequal diameter, being on the one 
place very thin, on the other, varicose, like the fibres of the 
spinal marrow. In the peripheral part of the glossopharyn- 
geal nerve of a frog, three months after the section, their size 
was only about one-sixth to one-third of the original fibres; 
they resembled, therefore, much more the ramifications of the 
nerve in very young frogs. In the central part of the cut 
nerve the fibres remain unaltered. Concentrated acetic acid 
dissolves the membrane of the newly-formed fibres, leaving 
fusiform nuclei : the membranes of the original fibres are com- 

1853.] Influence of the Sympathetic Nerve, §c. 311 

pletely dissolved, no nuclei being left. The reproduction of 
fibres, and the return of function, proceed in the same propor- 
tion. Of great importance are Dr. Waller's experiments for 
the understanding of the structure and function of the ganglia. 
While, as he has previously shown, all motor nerves, separated 
from their cerebrospinal centre, become entirely changed in 
their microscopic appearance, the peripheral part of the sensi- 
tive spinal nerves, the root of which is cut through between the 
spinal cord and the spinal ganglion, remains unaltered as long 
as the connexion with the ganglion is maintained. Ten or 
twelve days after having divided one or both of the roots of the 
second cervical nerve, he was enabled to make the following 
observations: 1. That part of the sensitive nerve which is 
situated between the place of division and the ganglion, is 
disorganized in the same manner as any dissected nerve in its 
peripheral end. 2. Tracing the disorganized fibres into the 
interior of the ganglion, they are seen mixed with normal 
fibres; the disorganized ones appear to pass into ganglionic 
globules, which are likewise altered, seeming to be deprived of 
their contents, and to consist merely of a thin, indistinct mem- 
brane. 3. The normal fibres appear to end by very thin fila- 
ments passing into the normal ganglionic globules. 4. Ail the 
fibres originating within the ganglion are in their normal state. 
5. The motor fibres are completely disorganized in the whole 
of the peripheral part of the nerve [no motion is produced by 
galvanism, or any other stimulus]. 6. After having divided 
only the posterior root, all the fibres below, or on the other side, 
of the ganglion were normal. 7. After having divided the 
nerve below the ganglion, or after having cut out the ganglion, 
all the fibres in the peripheral part were disorganized. It is 
evident, from fhis, that the spinal ganglion acts as a nervous 
centre for the sensitive fibres, but not for the motor ones. Dr. 
W. promises to give soon more detailed observations, as well 
on the same subject as on the function of the nervus vagus and 
svmpatheticus. — [Mulleins Archives. Brit, and For. Medico- 
Chir. Rev. 

On the Influence of the Sympathetic Nerve on the Animal Tem- 
perature. By Dr. T. Budge. 

To the communication of Bernard's observation, that by 
dividing the sympathetic nerve between the first and second 
ganglion cervicale, the temperaxure of the corresponding side 
of the head soon rises several degrees, and remains increased 
for some days ['Compt. Rendus,' Mars, 1852], Dr. Budge adds 
the remark, that he had observed the same fact already in De- 

812 Treatment of Spasmodic Diseases. [May, 

cember, 1S51. In another experiment, Dr. Budge destroyed 
the lumbar part of the spinal marrow, after which he observed 
a considerable decrease of temperature in the whole of the pos- 
terior part of the body. — [Froriep's Tagesber. Ibid. 

Treatment of Spasmodic Diseases. 

Dr. Alexander Wood, in an interesting paper {Monthly 
Journal of Medical Science, February. 1853,) points out the 
irrational and contradictory treatment usually pursued in spas- 
modic diseases. In the severer convulsive diseases, as tetanus 
and hydrophobia, he remarks, wine, brandy, and opium — stim- 
ulants — are conjoined with the cold affusion or cold bath — 
sedatives. Opium in small doses, which as a stimulant and 
soothing remedy might prove useful, is counteracted by tobacco 
a sedative, or by irritating and depressing purgatives. We 
are told to administer the most violent purgatives in these 
diseases, and are encouraged to persevere in their employment 
to an enormous extent, by the hope of eventually obtaining 
from the bowels an assortment of strange and heterogeneous 

"In these diseases," he adds, "where the violent muscular 
effort demands a large supply of blood, and where the wants of 
that supply increases the irritability of the system, we are 
taught to bleed, beginning with from thirty to forty ounces, and 
repeating it if need be. What end can bloodletting possibly 
subserve, unless in those exceptional cases, to be afterwards 
specially considered, where urea exists in the fluid ? There is 
no morbid matter in the circulating fluid which bleeding can 
remove ! There is no inflammation which it can subdue ! On 
the contrary, that terrible muscular action, like a consuming 
fire, is draining away the nutriment of the system even faster 
than your relentless lancet, and when the supply is exhausted 
the flickering taper will expire. 

" In the case of an unhappy infant, ill-thriven, ill-fed, who lias 
imbibed irritability of constitution with the milk of a gay, luxu- 
rious, self-indulgent, and nervous mother, and who has had 
that irritability confirmed by a long course of ill-regulated man- 
agement ; why will you, when the irritation of a tooth has 
proved the cause of convulsions, not rest satisfied with removing 
the immediate pressure, and then set about improving the 
general system, in which the real danger lies, but apply cold 
to a head where no symptoms of congestion or inflammation is 
to be found, harrow the gums with daily scarifications, and ad- 
minister a powerful purgative, glorying in the expulsion of 
depraved secretions, which oDly indicate the impaired stale of 

1853.] Treatment of Spasmodic Diseases. 313 

nutrition, and the necessity for a very opposite kind of treat- 
ment ?" 

Dr. Wood very earnestly solicits attention to the following 
therapeutical considerations, based on the physiology and 
pathology of spasmodic affections : — 

1. The importance of great attention to a proper supply of 
nutriment and of air in all circumstances where either heredi- 
tary tendency or other circumstances are likely to develop 
convulsive diseases. Trismus nascentium is epidemic in the 
West Indies, from the absurd way in which infants are there 
treated. The same disease was banished from the Dublin 
Lying-in Hospital by proper attention to ventilation and clean- 

Laryngismus stridulus is never so satisfactorily treated as by 
change of air. The mortality of tetanus in our naval stations 
in the West Indies has been very much reduced, mainly ac- 
cording to Dr. Dickson, by improved hygiene. — (Med. Chir. 
Trans, vol. vii. p. 765.) 

2. Let us divest our minds of the idea that it is necessary to 
treat the fit in any of these diseases. It is only a part of a train 
of morbid phenomena, and though the part most striking to the 
bystander, ought not to make the same impression on the intel- 
ligent physician. No one now thinks of treating the fit either 
in epilepsy or in chorea, and why should we think it necessary 
in tetanus or hydrophobia? 

3. Is it not worthy of consideration whether the obstinate 
constipation in tetanus and lead poisoning may not be a spasm 
of the muscular coat of the intestines^analogous to that of the 
voluntary muscles, and like it, not to be overcome by brute force 
(i. e., purgatives?) Certain it is, that in lead colic the finger, 
introduced into the rectum, is held by the sphincter as by a 
vice, and pressed tightly by the gut, and that this pressure re- 
turns at each paroxysm.* Certain it is also, that the retrac- 
tion and hardness of the abdomen, associated by Meratf with 
that internal construction, is found also to exist in tetanus, 
though I am not aware that any one has ever explored the inter- 
nal state of the bowel in that disease. It may be necessary to 
remove the morbid secretions in the bowels, though every intel- 
ligent physician will have to balance the amount of irritation 
produced by their presence with that caused by the drastic pur- 
gatives necessary for their removal. The spasm which retains 
them is the effect of the disease. It is to treat symptoms, to 
attack it alone; and when we succeed in overcoming the disease, 
the bowels will spontaneously relieve themselves. TrallesJ 

* Tranquerel— Traite des Maladies de Plomb. etc, p. 210. 
t Traite de la Colique Metalique. 
: Opii. Usus et Abuses, sect. 2. p. 260. 

314 Treatment of Spasmodic Diseases. L^ay, 

found opium succeed in a case of ileus where purgatives had 
failed. J have seen the same. Lentilius* has confirmed this ; 
and in a severe form of colic, Bonnf became convinced by ex- 
perience that it was the most powerful remedy. 

4. The most efficient and the most frequent agents in the 
production of these diseases are sedatives. Bloodletting is a 
most powerful sedative, and if carried to an extent in a healthy 
person produces convulsions. Is bloodletting, then, a suitable 
remedy in these affections? In chorea, it was formerly 
practised, and is now abandoned, from the injurious effects 
which it produced. In delirium tremens and hysteria, its use 
has been also given up. In epilepsy, it is rarely used by intelli- 
gent physicians, except to meet the requirements of secondary 
affections; and if we still retain its employment in the more 
severe convulsive diseases, it is probably only because their 
rapid course and frequently fatal issue makes it very difficult 
for us to ascertain the effect of any treatment. 

5. In one class of convulsive diseases bloodletting seems, in 
the present state of our knowledge, to be indispensable. Where 
urea exists in the blood and produces convulsions, it must either 
be expelled or counteracted. We scarcely know how to 
accomplish the latter indication, and therefore are driven back 
on the former ; but even while seeking by bloodletting to get 
rid of the urea which is mixed with that fluid, we must never 
forget that it "both acts on the nervous system as a narcotic 
poison and impoverishes the blood, inducing degeneration of 
the tissues ;"J and that therefore, while we take blood to re- 
move the poison, we rrnpst do our utmost to replace the nutri- 
ment which we are unavoidably compelled to abstract along 
with it. 

6. Our views on this subject would become more definite and 
precise, could we avoid imagining that spasm implies augment- 
ed strength. It is not easy for us, when seeing the violent 
agitation of the system which prevails, to divest our minds of 
the idea of great power being developed, but the same remarks 
apply to mania, in which disease, thanks to the exeriions of Dr. 
W. A. F. Browne, || general depletion, tartar emetic, brisk 
cathartics, and ice to the shaved scalp, are no longer in such 
vogue as they once were. 

If such are the objections to the routine practice, what course 
ought to be pursued? It is easier to point out error than to 
demonstrate truth. But I venture to suggest — 

*Eph. Mat. Cur. dec. 3, ann. 1, p. 131. 
t De Officio Medici. 

I William's Principles of Medicine, p. 150. 

II Monthly Journal, 1841, p. 75. 

1853.] Treatment of Spasmodic Diseases. 315 

7. That sedatives should be cautiously used. Chloroform 
and cold affusion have each proved fatal in delirium tremens. 

8. That every effort should be made to put into the system 
as much nourishment as it is capable of beneficially employing. 

9. But, if there is any faith to be placed in antipathic treat- 
ment, it is to stimulants we must most trust. 

10. It is worth observing, that most of those chemical agents 
which produce convulsions, acting, as has been already said, in 
large doses as sedatives, do in small doses act as stimulants. 

11. We find also, that where the minor spasms, as cramp, 
have been excited by irritation of the peripheral distribution of 
one class of nerves, as those of the mucous lining of the bowels, 
they are often relieved by irritation of the peripheral distribu- 
tion of another class of nerves, as by friction on the skin. 

12. The cerebral functions, more especially volition and sen- 
sation, being much in abeyance, any stimuli, whether mental, 
or phisical, by which they can be excited, should be freely given. 
It was on this principle that Boerhaave prevented the recur- 
rence of epileptic attacks, by directing a red-hot iron to be 
applied to any who might be seized.* 

13. The extreme sensitiveness to all irritations which exists 
whenever the spinal predominates over the cerebral system, 
suggests the propriety of enforcing the most absolute quiet, and 
preventing the access of all bodily and mental stimuli. In teta- 
nus and hydrophobia, the creaking ofa shoe, the slamming of a 
door, the sight or even the thought of water, or the gentlest 
zephyr playing on the surface of the body, excites a fit. Hence 
Armstrong tells us, that in tetanus those patients recover best 
who get little active treatment, but are nursed, as it were 
through the fit.f 

14. And if sources of irritation ought to be prevented, those 
actually existing ought to be removed, but never by irritants 
which are more powerful than themselves. This surely gives 
sufficient latitude to the most devoted admirers of the gum 
lancet, the bolus, or the bag and pipe, while it suggests to him a 
little caution in these somewhat coarse though most popular 

15. And lastly, if I have not succeeded in pointing out any 
one remed) which stimulates the cerebral without exciting the 
spinal system, it is because few, if any such are known. It is a 
subject of investigation well worth attention. And if no par- 
ticular plan of treatment has been announced, which can be 
unhesitatingly recommended, I am perfectly satisfied if I have 
created any doubt as to the course which at present is too 

* Falconer on the Influence of the Passions, p. 100. 
t Lectures, edited byT. G. Thomson, p. 572. 

316 Pathology of Rheumatism and Gout. L^- a y> 

unhesitatingly followed. I think, at least, something has been 
done to show how much more constitutional these affections aie 
than is usually supposed, .and thus to open up new plans tor 
prevention, if not for cure. And if in acute mania, in puerperal 
insanity, in delirium tremens, in chorea, in laryngismus, and 
may I add in epilepsy also, empiricism or the influence of 
authority has induced us to abandon antiphlogistic treatment, 
and to adopt stimulant and soothing remedies, I do not despair 
of a sounder pathology soon prevailing in regard to this whole 
class of afflictions, and of the discovery yet being made, that 
they are much more amenable to treatment that has hitherto 
been supposed. — [American Journal of Med. Sciences. 

Pathology of Rheumatism and Gout. By Prof. J. H. Bennett. 

The present theory with regard to these affections is, that 
they are both connected with an increase of hthic acid in the 
blood. In rheumatism, this is dependent on excess of the 
secondary, and in gout, on excess of the primary, digestion. In 
rheumatism, however, there is considerable excretion of lactic 
acid by the skin (Todd,) whilst in gout there is an excess of 
soda, which, uniting with the lithic acid, produces a compound 
of lithate of soda, that may be detected as such in the blood 
(Garrod,) while sometimes it exudes into the cellular tissue of 
the skin, constituting tophaceous deposits. In both diseases, 
there is an undue balance between the excess of lithic acid and 
the power of excretion — in rheumatism by the skin, and in gout 
by the kidney. This pathology serves to explain the similitudes 
and differences existing between the two affections. In both 
there is a certain constitutional state dependent on deranged 
digestion, during which exciting causes occasion local effects. 
These exciting causes in rheumatism are bad diet, hard work, 
exposure to cold and wet, and its subjects generally are the poor 
and labouring population. In gout, the causes are good diet, 
indolence, repletion, or indigestion, and its subjects are for the 
most part the rich and sedentary. The local manifestations in 
both are acute wandering pains, with pain and swelling — in 
rheumatism of the large, and in gout of the small joints, constitu- 
ting the acute attack in the one, and the so-called regular attack 
in the other. These are combined with a tendency to various 
complications of the internal viscera, which are more or less 
dangerous to life. 

The general indications of treatment are, in both diseases (1.) 
so to regulate the nutritive functions as to insure a due balance 
between the amount of matters entering the blood as the result 

1853.] Treatment of Acute Rheumatism. 317 

of digestion, primary or secondary, and the amount of matters 
discharged from the economy by the excretory organs. (2) 
To conduct the acute attack to a favorable termination, care- 
fully watching the internal viscera, and being prepared to act 
with vigour should these become affected. Hence the treat- 
ment of these diseases resolves itself into what may be called 
curative and preventive — the first having reference to the acute 
attack, the second to the means most likely to hinder its return ; 
the one must be carried out by remedies which act upon the 
blood and excretory organs, the other by the management of 
diet and exercise. — [Monthly Jour. Med. Science. 

Treatment of Acute Rheumatism by Nitrate of Potash. By 
Prof. J. H. Bennett. 

Although the general pathology above mentioned [see pre- 
ceding article,] which considers rheumatism as a blood-disease 
may be considered on the whole as correct, we are not yet 
enabled to explain by it the symptoms of an acute attack of the 
disease, where, in addition to the constitutional disorder, we 
have local pain, occasional heat, redness and swelling, with 
febrile symptoms. Most practical men have attributed these 
phenomena to a superinduced inflammation, although it has not 
been shown that exudation occurs, or that it is followed by the 
usual results of that condition. Besides, its erratic character 
is opposed to what we know of the process of true inflamma- 
tion, and calling it an unhealthy inflammation in noway clears 
up the mystery. The real pathology of acute rheumatism, 
therefore, has yet to be determined, and as a preliminary step, 
a careful histological examination of the affected tissues is ab- 
solutely necessary. So far as I am aware, this has never yet 
been attempted, if we except some observations by Hasse on 
the Structure of the bones in rheumatism (see the Monthly 
Journal for June, 1847.) 

Our treatment of this disease, therefore, is purely empirical 
sometimes directed against the pain, at others against the sup- 
posed inflammation ; now attempting to combat the pathologi- 
cal condition of the blood, then striving to remedy its effects by 
acting on the excretions ; and not unfrequently giving specifics, 
in the hope that any change in the constitution, however pro- 
duced, may be beneficial. In no disorder, probably, has such 
a crowd of opposite remedies and plans of treatment been 
extolled, and yet none of them can be depended on, so that it 
has been imagined that six weeks' rest is the most useful pre- 
scription (Warren.) The latest author on rheumatism endeav- 
ours to explain this by observing, that this need not be won- 

318 Treatment of Acute Rheumatism. [May, 

dered at by " those who consider the true nature of the disorder 
and the variety of circumstances under which the physician 
may be called upon to minister to his patient's relief. The 
bleeding, which in the young, plethoric, and robust, may be 
necessary to allay excessive vascular action and cause free 
secretion, may in the weakly induce irritability of the heart, 
and a consequent attack of cardiac inflammation. The opium, 
which in one person may prove of the greatest service in pro- 
moting fvee perspiration, and in allaying the general irritability 
of the system, may in another check the biliary and other secre- 
tions, and thus prevent the elimination of the rheumatic poison. 
The continued use of calomel, and the constant purging, which 
may be beneficial to one patient by removing large quantities 
of unhealthy secretions, may unnecessarily exhaust the strength 
of another, and tend very greatly to impede recovery. And 
so in regard to every remedy which has been proposed. What 
is useful at one time proves useless, or positively injurious, at 
another; and the conclusion is forced upon us, that what is 
wanted * is far less the discovery of untried methods of treating 
disease, than of discriminative canons for the proper use of 
those we possess :'— far less the discovery of any new medicines 
than the adaptation of our present remedies to the exigencies 
of each case." (Fuller on Rheumatism, p. 73.) These judi- 
cious observations may serve to explain the cause of our failure; 
but until we obtain more exact information regarding the 
special pathology of rheumatism, it is in vain to hope for a 
rational treatment. 

For my own part, I generally treat rheumatism on what is 
called "general principles;" these are, to alleviate severe pain 
by anodynes, diminished excessive vascular action by moderate 
bleeding and saline antiphlogistics,and encourage every attempt 
at critical discharges by diaphoretics, diuretics, purgatives, etc. 
Occasionally I have tried the effects of special remedies in this 
disease, and watched a series of cases, all of which were treated 
in the same manner. Thus I have tried aconite, and believe 
that alone it is of little service; colchicum, also, I have given 
frequently, and am of opinion that in pure rheumatism it is of 
no advantage, although in gout it is invaluable. This session 
(1851-2) you have witnessed another trial of this kind with the 
nitrate of potash, a remedy formerly recommended by Dr. 
Brocklesby, and which has been given with good effect by M. 
Gendrin, in the wards of La Pitie in Paris, as recorded by Dr. 
Henry Bennett (Lancet 1844, vol. i. p. 374.) It has more lately 
been pressed on our attention by Dr. Basham (Medico- Chir. 
Trans, vol. xxxii.,) who tells us that from one to three ounces 
oi the salt, if freely diluted in water, may be taken by the 

1853.] Miscellany. 319 

patient in the course of twenty-four hours, without any injurious 
results, but with the effect of relieving in a marked manner the 
swelling, heat, and pain in the joints. — [76. 

ill 1 c 1 1 1 a n g . 

We have received from a much esteemed correspondent a commu- 
nication having for its object the criticism of an article to be found in 
the original department of one of our late numbers. The writer takes 
exception to the treatment of the case, and gives his reasons for thus 
differing from the reporter. While we can perceive some advantages 
to be derived from such criticisms, we also feel assured that the evils 
w'ould very far counterbalance them. There are few, very few, men 
who can discuss a question, even purely scientific, without forgetting 
the proprieties without which any controversy may degenerate into 
personalities. It is therefore that we have invariably refused to admit 
into our columns any thing having the least tendency to such a result. 

It may be well, on the present occasion, to reiterate, that in pub- 
lishing original communications, with the name of the author, we 
cannot hold ourselves responsible for any theories, opinions, or modes 
of practice they may advocate. We have frequently published 
articles containing views, theoretical and practical, utterly at variance 
with what we would deem correct — yet the name of the writer being 
given, he can alone be responsible for the impression made upon the 
reader. If we were to publish none but such as we could endorse in 
every particular, we apprehend that we would soon incur the odium 
of being unnecessarily fastidious. 

The true policy is to let every writer stand upon his own merits. 
If he publishes nonsense, he will soon cease to be read and to do mis- 
chief: if, on the contrary, his contributions are found to indicate 
thought, judgment, and a well stored mind, he will be duly apprecia- 
ted and read with advantage. An Editor, it is true, has the privilege 
of rejecting such communications as may be deemed unworthy — and 
we do not hesitate to exercise the right whenever necessary — yet we 
always, feel inclined to make periodicals as democratic as possible by 
lending their pages to whoever wishes to be heard — provided he 
knows how to write. 

Books Received. — We have before us the "Proceedings of the 
Medical Association of the State of Alabama, at its sixth annual meet- 
ing held in the city of Selma in December, 1852." This is a neat 

320 Miscellany. [May, 

volume of about 170 pages, filled with interesting matter, and highly- 
creditable to the profession in our sister State. We hope to be able 
to refer to it more at length in our next. 

We have also received the "Tenth Annual Report of the Mana- 
gers of the State Lunatic Asylum of the State of New York." The 
" Report of the Eastern Lunatic Asylum in the city of Williamsburg, 
Virginia, for 1852-3." "The Philosophy of Medical Science, con- 
sidered with especial reference to Dr. Elisha Bartletl's Essay on the 
Philosophy of Medical Science. A Boylstown Prize Essay, 1849. 
By E. Leigh, M. D. Boston, 1853. Addresses to the Graduates of 
their respective Schools, by Prof. J. W. Richardson, of Nashville; 
by Prof. N. S. Davis, of Chicago ; by Prof. M. M. Pallen, of St. 
Louis ; and by Prof. H. V. Wooten, of Memphis — all of which evince 
a high order of talent. 

More Medical Journals. — We have received " The Virginia Medi- 
cal and Surgical Journal," edited by George A. Otis, M. D. and 
Howel L. Thomas, M. D., published monthly at Richmond — price 85. 
Also, " The American Psychological Journal, devoted chiefly to the 
elucidation of Mental Pathology, and the Medical Jurisprudence of 
Insanity," edited by Edward Mead, M. D., and published at Cincin. 
nati — 32 pages Bi-monthly at $1. We cheerfully add them to our 
list of exchanges, and wish them a successful career. Our Virginia 
friends manifest a degree of industry and good taste, as well as of 
ability, which must secure to them an extensive patronage. 

Dr. Frank A. Ramsay has, it appears, abandoned the East Ten- 
nessee Record of Medicine and Surgery, and joined the editorial corps 
of the "Southern Journal of the Medical and Physical Sciences," 
published at Nashville. 

The Country Doctor. — Some of our contemporaries pride ihem- 
selves upon never quoting anything from "the secular press ;" but 
we have always preferred to adopt the wiser course suggested by the 
motto of the Southern Medical Journal — "je prends le bien ou je Ie 
trouve" — and in so doing do not feel that any one's professional digni- 
ty has been injured, or any one's professional robe sullied by. contact 
with the common herd. Acting on these principles, we give below an 
article from the Knickerbocker, entitled " The Country Doctor, a 
faithful autobiography : by Glauber Saultz, M. D." Perhaps all our 
readers can narrate facts which surpass these ; we are sure almost 
all can equal them ; but then it is easier to laugh at another's misfor- 
tunes than our own, and "Doctor Saultz V feelings will not be hurt 
if every one laughs as hard as it will answer for a dignified m. d. ; 

1853.] Miscellany. 321 

neither will he make a charge for his visit. — [New Hampshire Jour- 
nal of Medicine. 

I had stumped about the country for a dozen years or so, in the 
same equipage, having wonderful success in curing "cases," but half 
the time cheated out of the credit of it by catnip tea. I took a notion 
to cast up my books to see how rich I was, and what could be made 
of outstanding accounts. It cost a great many evenings of hard work 
to arrive at the knowledge that, all debts being paid, 1 was not worth 
a " brass farthing " — not a red cent. Notwithstanding all the lucra- 
tive cases of typhus which I had managed, I remained poor. I be- 
lieve that people in the city pay their fees with alacrity, because the 
charges are exorbitant. When a bill for a hnndred dollars, for look- 
ing two or three times at a sick child, is presented to one who lives 
in a well furnished house in the upper part of the town, the very 
largeness of the demand is a delicate compliment upon his ability to 
pay. The man of the house sits down at a handsome secretary, and 
draws out a clean check for the full amount, saying " Doctor, you 
are very moderate : now that Jacky is out of the woods, come in, in 
a sociable way." 

As soon as the messenger is gone, the paterfamilias exclaims, 
"What an outrageous bill! It is an expensive luxury to be sick." 
However, it has its advantages to be attended by a fashionable doctor, 
as it has to worship in a fashionable church. On one occasion I was 
called in midsummer to attend a sick man on the sea-shore. After 
several days, his family physician, the renowned Doctor Jallaps, ar- 
rived from the city, and the patient was soon after on his legs, no 
thanks to me, and ready for the surf. 

" How much are you going to charge him ?" said Doctor Jallaps. 

"Twenty-five dollars," said I. 

" Poh !" said he, " make it a hundred. He expects it." 

"If he expects it," said I, "it would give me great pain to disap- 
point his expectations ;" whereupon I acted advisedly, and received 
an honored check for a round C. on the Phoenix Bank. 

On another occasion, when attending one of my own patients in the 
same vicinity, while crossing the " big bridge " when the tide was up, 
I came near being drowned. My sulky was soon afloat, but the horse, 
being a good swimmer, reached the opposite bank. Now, besides 
risking my own life, I fiirly dragged the patient from the very gates 
of death. I got him out of a bilious remittent, drove tbe jaundice out 
of his skin, and when I came to ask him for ten dollars, he black- 
guarded me like a chicken-stealer, and would never employ me again. 
The fact is, that people in the country abhor taxes, and a doctor Ts the 
worst of publicans. To be sick they think is a dead loss, which they 
unchristianly grumble at ; but to have to pay for being cured irritates 
them beyond measure. Oh ! how meek they are when they lie 
prostrate in a burning fever — when their teeth chatter, and the whole 
house jars with their shaking ague ! Oh ! how welcome the latch is 
lifted up to admit you when life seems to hang upon a hair ! But get 

322 Miscellany. [May, 

them on their legs, and the first thing which they forget will be that 
they were ever on their backs. If many of them do pay you, it is 
under protest, procrastinating the settlement to a time when the ac- 
count might be outlawed, clipping down the fair proportions of a just 
bill, and giving you the most ragged representative of money. 

I say that when I came to overhaul my accounts, I was not worth 
anything, and therefore arrived at the conclusion that it was high 
time to marry a wife who would take care of my money. I did so, 
and found my condition better, but for some years had a hard time of 
it. My children were extremely pettish and peevish, and what with 
nocturnal calls, I had not a night's rest for five years. If anything 
ailed them, they were sure to cry the night long ; but if they were 
well, they woke up long before the crowing of the cock, climbing 
over me at the very moment when I had composed my head for a 
short morning nap. But paternal philosophy can well be reconciled 
to the sweet music of "cn'ing babes," some thousands of which have 
been imported into New York during the present year. But the 
number of people taken sick in the day time, who send for the doctor 
at night, produced a compound fracture of my time, which seldom gave 
me a comatose state. It is the sweetest of all consolations to lay a 
weary head upon the pillow, with the thought that rest awaits you 
until the dawning light. Whatever carking cares have vexed you, 
that is a long season of immunity which stretches through the dark 
hours of the night. Then do the strained muscles lapse into the most 
easy attitudes in the yielding couch, and the taxed intellect is still, and 
you bolt the door upon ingratitude and strife. 

But to lie down without security from disturbance is enough to 
frighten away sleep. Such is the lot of a country doctor. I could 
relate innumerable instances of the utter disregard with which he is 
routed from his bed, without occasion, at all hours. Here is one in 

I arrived late one winter evening at my own door, after a hard day's 
toil. With what a feeling of relaxation did I divest my feet of heavy 
boots, set them smoking at the fire, and then regale them in easy slip- 
pers ! Then, wrapping about me a soft padded gown, with what 
luxury did I fall back in my arm-chair, peruse the daily paper, and 
sip a cup of tea! "Now," said I, "the labors of the day are over. 
A storm is brewing out of doors. I hope that no body will come here 
to-nighl. If they do, I won't go. Let them go after Bogardus. I 
won't immolate myself for anybody. It is unreasonable." With 
that I pulled down my ledger and made a note of the day's visits, one 
half of which were to poor houses, negro huts, and Irish shanties. As 
to this class, they loved me like a brother, and their confidence in me 
was unbounded. They sent for me if their bones ached, or if their 
corns hurt them, and I went with all speed, though I sometimes had 
occasion to scold them. Before retiring for the night, I opened the 
outer door, as was my custom, to see the state of the weather. It was 
a tremendous night. The moon shone palety, but the wind blew a 
hurricane. It rained, it hailed, it snowed, it Slowed. I thought again 

1853.] Miscellany. 323 

of the poor mariners on the coast, and with a silent prayer for them, 
and all houseless, unprotected ones, I closed the door, and went to bed. 
I had just recovered from the shivering sensation of cold sheets, and 
become conscious of grateful warmth, while that delightful drowsiness 
which borders upon sound sleep stole over me, when there came a 
knocking, impatiently repeated, enough to wake the dead. "Bless 
me !" I groaned out, crawling out of bed, and lifting the sash, *• what 
do you want ?" 

11 Doctor, want you to come right straight away off to Bank's. His 
child's dead." 

" Then why do you come ?" 

"He's p'isoned. They gin him laud'num for paregoricky." 

" How much have they given him V 

" Dono. A good deal. Think he won't get over it." 

" When did they give it to him ?" 

"This arternoon." 

" Why didn't you come sooner ? How do you think I am to go two 
miles on such a night ? Have you brought a wagon?" 

" No." 

" Then I won't go. Tell them to ;" and having prescribed 

hastily out of the window, I closed the sash, and went back to bed. 
But the howling wind and rattling sleet against the panes had not that 
soothing effect which they have to one who lies snug and warm and 
irresponsible in his couch. " What," said I, " if that child should die 
through my neglect ! Will it absolve me from criminality because the 
parents are poor ? I will go : I must." With that I leaped out again, 
kindled a match, and went down into my office. Not choosing to 
wake my man Flummery, or to disturb my old horse, who was 
craunching his oats, and housed for the night, I took my slick, and 
set out to walk. The snow water went through my shoes like a 
sieve ; my neck and bosom were instantly covered with sleet. Nev- 
ertheless, I had some humorous thoughts while breasting the storm, 
and composed a Latin distich by the way. I had just got the last foot 
of the pentameter correct, when my own foot struck against some- 
thing which looked like a black log. On scrutiny, by the light of 
the moon, I found it to be my old patient, Timmy Timmons, apparent- 
ly sound asleep, with his beloved rum-jug by his side. In vain I shook 
him, to make him aware of his situation, and see if the spirit had left 
his body. I shook the rum-jug, but there was no spirit there, not a 
drop. "Timmy," said I, " wake up." No answer. I then kicked 
him, but he bore it as if he had been used to kicks. "He is dead," 
said I, and passed on to the next house. There, while opening the 
gate, I was fiercely attacked by a stout bull dog; and while keeping 
him off, and fighting my way up to the house, the master came out in 
his shirt-tail with a loaded gun. " Don't you know me ?" said I, as 
he examined the priming ; " it is the doctor." 

"Souls alive !" responded he ; "I thought it was a thief! I'm 
glad you spoke when you did. In a minute more I should have popped 
you over, Doc'. Sorry to do that. My son John's got the fever- aig. 
Here, Bull, Bull, Bull, Bull !— g'home, sir!" 

324 Miscellany. 

"Timmy Timmons," said I, " is lying out in the lane, drunk or 
dead, I don't know which; dead drunk, at any rate. He must be 
looked after." 

"Wait till I put on my breeches. What a wonderful night! 
Won't you come in and git warm V' 

" No : get on your breeches, and make haste." 

" Guy ! when I first heered you, I thought it was Lawrence comin' 
to break house. He's a desput fellow. So I gets up and looks out o' 
the window, and then I went into the corner to find my gun, and if I 
didn't " 

" Come, come ; do you want " 

" To get the rheumatiz ? No, I don't. Hold on, Doctor ; be down 
in one minute." 

We returned to the congealed Timmons. My coadjutor took up 
the jug, shook it, and said, "Not a drop." He then smelt it. 

"It is rum," said ., "the cause of all this misery." 

"No, Doctor, not all rum ; there's been a little molasses into the 
jug. by the smell of it." 

"Lift him up," said [. He did so, and carried his burthen home, 
where I brought Timmy to life. 

"I now trudged on upon my original errand, hoping to save ano- 
ther life more valuable than that of Timmons. Arrived at the house, 
I perceived it shut up as if hermetrically sealed. Not a light was to 
be seen. I knocked furiously, and at last a nightcap appeared from 
the chamber window, and a woman's voice squeaked out, " Who's 
there V 

" The doctor, to be sure," said I ; " you sent for him. What trie 
dogs is the matter ?" 

"Oh, its no matter, Doctor. Ephraim's belter. We got a little 
sheered, kind of. Gin him laud'num, and he slept kind o' sound, but 
he's woke up now." 

" How much laudanum did he swallow?" 

" Only two drops," said she. "T asn't hurt him none. Wunner- 
ful bad storm to night !" 

I buttoned my coat up to my throat, turned upon my heel, and 
tried to whistle. 

"Doctor, Doctor!" 

"What do you want?" 

"You won't charge nothin' for this visit, will you?" 

Now, as I travelled back on foot, the moon became obscured, the 
driving sleet blinded the eyes, I heard the Atlantic breakers booming 
and beating upon the coast; and with head down, like a bulrush, I 
arrived at my own door, wet and disconsolate, saying to myself — 
" That little plant called Patience does not grow in every 

Orfila, the great Toxicologi&t, is no mare..— The Parisian papers are full of the 
honors paid to his memory. His funeral was attended by upwards of fifty 
thousand persons, and eulogies were pronounced at his grave by seven distin- 
guished representatives of the Scientific bodies of which he had been a member. 



Vol. 9.] NEW SERIES— JUKE, 1851. [No. 6. 


©riginal (!Iommunuattrjtt0. 


Cases of Malignant Spotted Fever; — with Remarks. By 
Arthur W. Preston, M. D., of Americus, Ga. 

The following cases of malignant spotted fever are sent for 
publication, — it may not be amiss to state that, in their delinea- 
tion and treatment, the utmost frankness is observed : 

During the past twelve months, all the endemic diseases 
have increased in number and intensity. The first months pre- 
senting serous diarrhoeas, cholera infantum and cholera morbus, 
with occasional cases of angina pharyngitis. From June to the 
middle of September, intermittents and remittents, together 
with melanosis and carbuncle. From the middle of September 
until November, malignant double tertians, some few algid, 
others combined with semi reaction — in which inflammations 
of the asthenic type prevailed — which if not promptly treated 
passed within a few hours into profound and irremediable con- 
jestion. Carbuncles have not diminished from their first ap- 
pearance up to the present time. From November to the 
present, the following diseases have been in existence: Inter- 
mittents, chronic and relapsing; measles, very abundant ; con- 
gestive pneumonia ; congestive bronchitis; typhoid pneumonia 
and spotted fever — the latter disease is the one which I shall now 
speak of. 

In Copland's Medical Dictionary, page 1176, will be found 

n. s. — VOL. IX. NO. vi. 21 

326 "Preston, on Malignant Spotted Fever. [June 

an article upon Spotted Fever of New England, which bears 
a strict analogy to the cases we have recently met — in which 
the primary lesion must have been upon the ganglionic nerves, 
and the second upon the vascular system. So great was the 
rapidity of the attack in four cases, although sent for immedi- 
ately, we had not time to reach them before they were dead or 
dying. As these diseases sprung upon us without premonition. 
we were entirely unprepared to determine what would be the 
general outlines, should more present themselves. It is an easy 
matter to point out defects when too late to remedy the evil. 
That no more shall follow, I beg permission to review the nature 
and treatment before I submit to your criticism, after which, 
any light you may deem proper to throw upon them will be 
thankfully received. 

Case I. March 28th, 1853. Russel Jenkins, aged 22— 
sanguine nervous temperament, five feet seven inches high, 
weight 130 lbs., occupation a farmer, habits perfectly tem- 
perate and industrious, circumstances good — on the 27th, 
in the afternoon, complained of general indisposition: took a 
dose of salts, which operated five times ; after which, continu- 
ed to grow worse to the time I saw him on the following 
morning at 8 A. M., at which time the countenance was altered 
from a florid to an exsanguious appearance ; the eyes were 
peculiarly brilliant and jactitating; lips pale; tongue broad, 
flat, thin, and very pale, but firm in fibre; teeth cold, dry and 
dead ; very restless, tossing from one side of his bed to the 
other; acute lancinating pain in the head; soreness of the 
muscles and joints ; stiffness and soreness on the back of the 
neck; some sore throat ; pulse 80, full and compressible ; great 
anxiety and constant thirst; occasional delirium; hysterical 
symptoms. Had been vaccinated four weeks, previous to 
which his health had been very good ; but since, had been 
from time to time troubled with pains in his joints, and thought 
he had rheumatism. Two days previous to confinement he 
helped to ditch, and was above his ankles in water the greater 
part of that time, during which he thought he had fevers. 

Diagnosis. — I was slow in forming an opinion as to the pre- 
cise character of his disease. The more I looked at it, the 

1853.] Preston, on Malignant Spotted Fever. 327 

more I was puzzled, and shall not fear censure when I confess 
the following : At one time, I thought it a retrocession of 
rheumatism upon his brain — at another, of the secondary vac- 
cine fever. Again, that some malignant exanthema had con- 
centrated all its powers upon the cerebro-spinal axis. The 
progress of the case determined the justness of the latter con- 

With appearances so malignant, and uncertainty as to the 
correctness of my diagnosis, I trusted to general principles for 
my guide. I therefore summed the following symptoms: — 
1st, the general exsanguiousness ; 2d, the cold, dry and dead 
teeth ; 3d, restlessness, &c., and resolved to support the vital 
pow T ers as I best could, until further indications. Instead of 
his being benefited by the free purgation on the previous day, 
he rapidly grew worse — a weighty argument against venesec- 
tion. He was ten miles from town ; I therefore did not ask 
for consultation, but gave the following: Hyd. sub. m. gr. 3, 
ipecac, gr. 2, morph. sulph. gr. J, every eight, and sp. aeth. nit. 
every four hours. A blanket was divided into three parts, 
immersed in hot water, and well sprinkled with turpentine — 
then applied over the thorax, abdomen, feet, legs and knees. 
The first dose of nitre was immediately rejected, together with 
a pint of green fluid, mixed with mucus. 10 A. M. More 
quiet ; blood returning to the surface ; headache not so severe. 
12 M. Headache better; tongue red. 

29th, 8, A.M. Had slept but little during the night. Fami- 
ly thought he would die before morning. Is now watchful, 
restless, and constantly occupied about his farm ; motions auto- 
matic, and passes rapidly from one idea to another. 4 P. M. 
Was visited by Drs. Barlow and Vagt, in company with my- 
self. The conjunctiva was beautifully injected, and the eyes 
peculiarly brilliant ; there is much more calmness, and answers 
our questions rationally ; headache is greatly diminished — the 
pills have procured three bilious operations. Treatment, as 
before. After our leaving him, continued to grow worse, and 
passed a very restless night, slept none, and was constantly 
fighting his brothers, one of whom he bit on the arm. Durino- 
the night, he got out of his bed and climbed the logs up to the 
joists before they could control him. 


Preston, on Malignant Spotted Fever. [June, 

30th, 10 A. M. All the symptoms had now become greatly 
aggravated; const mt jactitation; tries to get out of bed so 
that he may work. Typhomania. — On t he arms and body 
there are several ecchymoses, from the 12th to the \ of an inch 
in diameter, their edges jagged and somewhat raised with a 
few vesicles. On close examination, a few rose-colored spots 
about the size of a duck-shot, smooth and circular, and others 
twice or three times as large, resembling a blood-blister. They 
were filled with a sen>sanguineous fluid. Blisters to extremi- 
ties, cupping on the nape of the neck to one half-pint, anodynes 
and diaphoretics, with wine, constituted the remainder of the 
treatment. He grew rapidly worse until he died, on the even- 
ing of the 31st. 

Remarks. — During the last two days of his illness, his deliri- 
um and restlessness constantly increased, until he completely 
exhausted his strength ; and when be no longer possessed 
strength to articulate, he muttered incessantly and gradually 
passed into a moan, which continued to his last moments. The 
blotches, after death, were conspicuous, and in all might have 
numbered two hundred or more. 

Case II. Marion Young, age 23, five feet six, weight 120 
lbs., temperament sanguine, circumstances good, lived five 
miles from Case 1st; previous health bad, was a dyspeptic and 
invalid; occupation a farmer — the brother in-law of case lst r 
and waited on him two nights before his death. 

April 1st, 10 P.M. Complained of headache, and vomited 
bilious matter ; general soreness of muscles and limbs. Did 
not think it necessary to obtain medical aid until early the fol- 
lowing morning. 

April 2d. Died at 11 A. M., without treatment. 

No post-mortem allowed. Deceased was covered with pur- 
ple blotches and ecchymoses over the whole body, and scarcely 
was there a square inch free from them — their general diameter 
was the } of an inch, some as large as a ten cent piece. From 
each nostril a large amount of bloody froth issued — there must 
have been a pint or more. 

Case III. Marion Jenkins, age 32, a farmer, and brother of 

1853.] Preston, on Malignant Spotted Fever, 329 

case 1st, and wes bitten on the left arm by case 1st, lived four 
miles from case 1st. 

April 2d. Was slightly indisposed the preceding night, and 
greatly alarmed — thought his brother might have been poison- 
ed, and looked to betaken ill himself; but when so taken, was 
not desirous to obtain medical aid. At 3 P. M. the following 
symptoms were noticed: — Headache; soreness of the limbs and 
muscles; body moist wiih sweat, and the hair around the 
temples perfectly wet with it; is disposed to sleep, but when 
awake his expression indicates alarm, and a close examination 
with a view to the reading our thoughts as to the nature of his 
disease; at times tries to throw around him an air of careless- 
ness, and says, Pshaw! — he knows he is not like the others, 
and is not going to be very sick. Drs. Barlow, Fish and my- 
self, agree upon the following for the night : — Infus. senna, I iv\, 
Mpjnes. sulph. 3ss., to be taken immediately. Liberal doses 
of morphine after the operation of the above, to quiet his fever 
and support his strength. 5 P. M. Sweating profuse, over the 
head, face and chest — large colliquative drops; begins to talk 
at random about his wagons and cart wheels, immediately 
after the operation of the senna and salts, which took place 
within five minutes after they were given, which were bilious 
and watery. Every appearance of rapid congestion was set- 
ting in with great force — Tr. opii. xxx. gtt., and in ten minutes 
xxx. more. The fever, which was before violent, and pulse 
120 to 130, full, but compressible, sunk to 90. Sweating 
diminished, together with the delirium, as it were by a charm, 
and prospects brighten. I should have stated that we discov- 
ered rose-colored spots upon his chest, arms and thighs, in 
number twenty, and one line in diameter: they were well 
marked, smooth and circular. On the left elbow there was 
one sero-sanguineous blotch larger than a pea, and its surface 
distinctly elevated. 9 P. M. Symptoms good, skin a little 
moist, and pulse 80 to 90. Tr. opii. gtt. xxx., with a draught 
as follows: — Infus. senna, 5j. ; senega, 3ss. ; magnes. sulph., 
3j ; zingib. 3ij. — to be repeated every four hours. 

April 3d, 1 A. M. Continues better; says he feels well, 
and wants to sleep. As there was from the first a disposition 
to profound sleep, I ordered him to be awaked when he slept 

330 Preston, on Malignant Spotted Fever. [June, 

too hard. 5 A. M. No change. 9 A. M. Has discovered the 
blotches upon himself, and says he knew he had the same dis- 
ease, but did not mind, as he knew he should get well. The 
blotches were now numerous — in all, perhaps, two hundred, 
or more. From a fine rose color they had passed to a muddy 
brown, and some of them looked as though he had been severe- 
ly pinched — were much darker, and towards the depending 
margin about \ was sero-sanguinous, with a cuticle resembling 
a blister: in fact, there were rose-colored, purple and dark, 
promiscuously over the whole body at the same time. One 
particular circumstance deserves mention : A large consolida- 
ted plug of mucus, mixed with blood, was blown from his right 
nostril — it was 2 inches long, \ wide, and nearly the same in 
thickness. 1 P. M. Camphor 5 grains, and tr. opii. gtt. xv. 
every four hours. There has been from the beginning great 
soreness of muscles and'stiffness of joints ; on the right forearm 
there is acute tenderness — the moment it is touched, be it never 
so tenderly, he cries out ; from the metacarpus to the phalanges 
of the fore-finger there is a deep inflamed blush ; the left thigh, 
leg and ankle are similarly affected. There is, moreover, 
swelling of the glands in his groins. 

April 4th, 10 A. M. There has been a febrile exacerbation 
the preceding nights, which abated after a mild sweat. There 
is now considerable soreness of the whole body, with deep red 
blushes on the affected limbs. The blotches have ceased to 
increase — they are all dark brown or purplish. Pulv. ipecac. 
3 gr., camphora. gr. 4, with infusion of senega every six 
hours; at night, 2 grs. hyd. sub. m. were added to each of the 
above powders. 

5th, 7 A. M. The calomel has produced three dark con- 
sistent operations, lie now becomes dejected, and is very 
solicitous about his recovery. His wife has importuned to give 
my opinion, and though several times I have declared almost 
positively he will recover, still she is frantic with the loss of 
hope. M. J. sees her distress and becomes more cast down. 
I endeavor to calm him, whilst he says, " I am worse, and shall 
die." " No, your prospects are bright, and you ought not to 
suffer yourself thus to be cast down, when your present weak- 
ness is produced by the operations, from which you will soon 

1853.] Preston, on Malignant Spotted Fever. 331 

rally." No, I shall die, and that before night ; you will see it, 
and I know I shall." To be taken immediately — tr. opii. gtt. 
xv. ; sp. am. aromat. gtt. xx. It was rejected in a few minutes. 
Again we gave am. aromat. gtt. xx., which produced a burn- 
ing sensation, and was therefore discontinued, and instead 
thereof a wine-glassful of poor port wine (the best we had). 
9 A. M. Is much calmer, and feels better. As he has not been 
left alone, without the presence of a medical man, since his 
illness, is afraid to be left, as he apprehends some sudden diffi- 
culty which may sweep him off: is, therefore, urgent in 
entreaties for Dr. Fishand myself to remain until Drs. Barlow 
and Vagt return. 4 P. M. Called with Drs. Barlow, sen., and 
junior. Is very much improved, and no longer retains the 
morning's presentiment. Dover's powders grs. v. with infu- 
sion of senega every eight hours. 

6th, 10 A. M. The blotches are disappearing, and contin- 
ues to improve. Pulv. camphorae, ipecac et opii. every twelve 

7th, 12 M. Has had fever the preceding night; blotches 
have nearly disappeared. Took ol. ricini. 1 ss. in the morn- 
ing — it griped severely. Ordered tr. opii. gtt. xv. et infusion 
senega every twelve hours. The inflamed places are nearly 
gone, and he lies with more comfort. Soreness up to this time 
has been too troublesome to admit his lying long in one posi- 

9th. Blotches gone ; speaks of going home next morning, 
which was allowed, owing to peculiar circumstances. 

Remarks. — In case 1st, the urine was very abundant until 
the last two days: it was slightly albuminous towards the lat- 
ter part — almost entirely suppressed, it did not exceed one 
tablespoonful, and was highly colored. 

In case 3d, the urine was abundant and slightly albuminous: 
on the fifth morning was scanty, and when boiled was brown- 
ish and muddy. Calomel was administered at two different 
times — first by Dr. Barlow, and next by myself. Although it 
mifjlit have done good, I believe it interfered with the critical 
sweats, and, therefore, prolonged the febrile exacerbations. 

Case IV. William Gaskins, age 30, five feet ten ; of a san- 

332 Preston, on Malignant Spotted Fever. [June, 

guine nervous temperament ; possessed a feeble constitution ; 
was crippled by extensive diffuse cellular inflammation, pro- 
duced by a wound in the knee. 

April 2d. Had nursed case 1st, and stayed up all night with 
case 3d — was extremely devoted in attention to (he latter. 
At 9 A. M. the following day, I was told Wm. Gaskins was 
afraid he had been sitting up with a case of malignant small- 
pox, and if so, he was certain he should take it and die. He 
soon after presented himself to Dr. B. and myself, upon which 
the following dialogue ensued : — " William, you are not afraid, 
are you?" "Yes, to tell the truth, I am ;" at the time tremb- 
ling and very pale. "What are you afraid of?" "The small- 
pox — they say it is the small-pox which killed R. J. and M. S., 
and I believe it is." Finding whatever we said to the contrary 
unavailing, we persisted no longer, but gave him tr. opii. gtt. 
xv., and a dose of senna, senega and salts. 

April 3d. Was visited by Dr. Barlow and myself. 6 P.M. 
Eyes very red and muddy ; face deeply flushed ; but one 
rose-colored spot upon the gastric region ; pulse 120, full and 
compressible; complains of severe pain in the head; gentle 
moisture over the body. A pint of bilious matter is vomited, 
and no relief follows. Thirst urgent and unassuageable. Or- 
dered senna, salts and ginger, every two hours, until free pur- 
gation ensued, and thereafter morph. sulph. gr. i, with sp. aeth. 
nit. every six hours. 

4th, 12 M. Was found by Dr. Barlow almost pulseless; 
features deeply altered, and extremities icy cold. There 
were deep purple blotches over the whole, with intervening 
spaces about half an inch in diameter. Wine and other 
stimulants were freely given, until Dr. Fish and myself saw 
him at IIP. M. He was then pulseless, rational, and the 
extremities flexed ; the ringers drawn in permanently upon the 
palms ot the hands; conjunctiva dry and puckered. Ordered 
sp. am. aromat. gtt. xl. in warm wine every fifteen minutes; 
sinapisms to spine, &c. 

Case V. April 3d. A stout negro man, belonging to Rev. 
Jasper Hayne, age 22, possessing previously fine health, lived 
five miles from the above cases ; had visited M. J. and staid 

5853.] Preston, on Malignant Spotted Fever. 333 

about the premises an hour — after which, went home, and 
was seen walking about the yard on Sunday morning. The 
same night, on Mrs. Hayne's return, was found lying upon his 
back groaning, but speechless and insensible. At 8 P. M. he 
died without treatment of any kind. 

Autopsy, eighteen hours after death. — Owing to very press- 
ing circumstances we only examined the thorax and abdomen. 
Upon lifting the sternum, the pleura was more than ordinarily 
dry; the pericardium was filled with serum ; the right ventri- 
cle was filled with dark clotted blood ; the left contained a fluid 
but dark blood. On the anterior outer wall of the heart there , 
were a few ecchymoses about the size of a duck-shot. The 
lungs were infiltrated with a sero-sanguineous fluid, and upon 
squeezing them a bloody froth exuded. The surface was mot- 
tled and very much ecchymosed. The cavity contained a pint 
and a half, or more, of serum. 

Abdomen. — The abdominal viscera presented a dry, muddy 
and brittle aspect ; the omentum was shrivelled, and the mesen- 
tery as if it had been parched. Upon the arch of the colon 
there was an ecchymosis the size of a ten cent piece — its color 
was mahogany. The viscera were otherwise healthy. 

Case VI. Mrs. Jenkins, age 62, the mother of case 1 and 3, 
had waited on both. The two died, and the third was taken 
ill at the house. Her health was previously good. 

April 9th, 9 A. M. Vomiting ; pain in the head, and general 
soreness of the whole body. 12 M. Was seen, and declared 
she should die: therefore, wanted nothing further than to make 
her die easy. At 6 P. M. she was a corpse. There were no 
blotches upon her body; countenance natural after death. 

Case VII. Olivia, an orphan girl, age 14; previous health 
good ; lived at E. G. Brown's, three-quarters of a mile from 
Mrs. Jenkins; had no communication with the above cases, 
save Wm. Gaskins, on whom she waited during his illness. 

April 9th, 10 A.M. Was taken with vomiting of bilious 
matter, and severe pain in her head. Saw her in the following 
condition at 7 P.M. — Eyes very red and muddy; lips had a 
fuliginous coating; was tormented with thirst, which no amount 

334 Preston, on Malignant Spotted Fever. [June, 

of water could assuage; pulse 130, and rather compressible; 
rose-colored spots upon the arms, chest and thighs — also 
ecchymoses as large as a five and ten cent piece ; at times 
delirious. This symptom appeared in all immediately after 
vomiting or purging. Cold water to head, and waited two 
hours to determine the propriety of bleeding. I had been ad- 
vised to bleed, and contrary to my prepossession did so to the 
extent of 14 ounces — after which she soon complained of cold 
feet. J gave her brandy directly after the blood was drawn. 
There was no syncope, nor a tendency thereto. To avoid evil 
results, I adopted all the necessary precautions, and gave, in 
addition to the above, tr. opii. camphorata, 3iij. : applied 
sinapisms along the whole spine, and warm bricks to feet. 
Within one hour and twenty minutes of venesection she was 
a corpse. 

Autop ay fifteen hours after death. — We were permitted, or 
rather implored, to examine but the brain. The pia mater and 
arachnoid w r ere deeply injected over the whole surface; the. 
veins were filled with black blood, and so numerous were 
the anastomoses of the arteries of the pia mater and arachnoid 
that the surface of the brain appeared of a rusty mahogany 
color; the membranes were shrivelled and dry; the ventricles 
contained no fluid whatever; the substance of the brain was 
very soft, and putrefaction far advanced. The integuments 
on the whole posterior surface of the body were of a thick, dark 
brown color. 

Case VIII. James Brown, son of E. G. Brown, age 15 ; pre- 
vious health good : had visited the sick, and was taken ill in 
the morning of the 9th, at the same time as Olivia. 11 A. M. 
Complained of soreness of muscles and joints, headache and 
vomiting. 7 P. M. Pulse 100, full and compressible ; rose- 
colored spots over the whole body. Gave the following every 
three hours: Sp. am. aromat. gtt. xv. ; ext. belladonna gr. -*-; 
pulv. camphorae gr. iii. Sinapisms along the spine. There 
being a muddy redness of the eyes, and some thirst, ordered 
abstinence from drink, for reasons hereafter to be stated. 

11th, 10 A.M. Very much improved ; blotches more abun- 
dant and dark colored ; there is great soreness of limbs. Pulv. 

1853.] Preston,o7i Malignant Spotted Fever. 335 

ipecac, co. gr. v. ; sp. am. aromat. gtt. xv. et ext. belladonna, 
every eight hours. 

12th, 11 A. M. Still improving, with less fever. Gave 
pulv. camphorae gr. iii. every eight hours; mucilage with 
ol. ricini. 3j. ; and sp. tereb. gtt. xv. Within a few minutes 
two large serous operations. He then complained of headache, 
and asked what should be done for it. Ordered, cold cloths to 
forehead, and sinapisms to abdomen, with tr. opii. c. 3ss. to 
be repeated until the operations ceased. On the next day I 
visited him in company with Dr. Bruce, and found him pro- 
foundly comatose: deglutition abolished; face swollen and 
suffused with a dark red; had had several spasms during the 
day, and the left side was drawn towards the right: the body 
is covered with dark brown blotches from the size of a small 
shot to a five cent piece. He died at 9 A.M. on the 15th. 
Throughout his illness, the soreness increased, together with 
redness and swelling of the joints. 

Case IX. Melissa Brown, (sister of the above,) age 5 years, 
was taken on the 9th of April, at midnight, and within one half 
hour from apparent health, her pulse was vacillating and com- 
pressible ; no headache. There were rose-colored blotches 
over her arms and thighs. Aromatic sp. of ammonia, together 
with camphor and belladonna, were given. The blotches 
continued to increase in number, and grew darker, until scarce- 
ly an intervening space was left. Quin. sulph. and wine 
were given, and a decoction of red oak bark applied over her 
body. Beneath the integuments of the neck and armpits there 
was a dark suffusion of blood ; the countenance was cadaver- 
ous and shrunken ; the pulse fluttering, and the slightest pres- 
sure would stop it — it required a nice touch to distinguish 
the systole from the diastole. All these symptoms continued 
to increase up to the morning of the 13th. I then with confi- 
dence addressed myself with a determination to rely on tr. opii. 
alone, and that in as large quantities as she could bear, be- 
lieving that had the others been treated with lull and free doses 
more would have been saved. Ordered, tr. opii. gtt. viij., and 
in four hours, tr. opii. gtt. x. Immediately after the first dose 
all the unpleasant symptoms disappeared, and she continued to 

336 Preston, on Malignant Spotted Fever. [June, 

steadily improve, with the addition of quin. sulph. gr. ii., and 
wine I ss. ter die. 

Case X. Mrs Brown, age 36, complained of being chilly 
on the evening of the 13th. There were small petechia? upon 
her arms — they were very dark. She firmly believed she had 
the disease, and would die. Gave her morph. Jj 
wine and quin. sulph. the next morning. Chilly and very much 
alarmed. There were several dark colored spots upon her 
legs — those upon her arms had not increased ; some headache. 
This lady had lost a mother, brother, brother-in-law, an orphan 
girl, and a son, by the same disease. She verily believed she 
should follow them. Grief — despondency were the circumstan- 
ces against her, together with two weeks watching and constant 
nursing. A lady of remarkable kindness, and whose solicitude 
knew no bounds. I therefore knew that I had an exhausted 
nervous system to contend with. Consequently, gave tr. opii. 
gtt. Ix. every twelve hours; quin. sulph. gr. iii. and wine every 
three hours. There ensued no further difficulty. 

Case XI. and XII. Were treated by stimulants and quin. 
some days before rose-colored spots appeared. They were 
not confined to their beds. I, myself, had undoubtedly rose- 
colored spots over my arms, abdomen and thighs. As a pro- 
phylactic I trusted to opium, stimulants and quinine, and have 
been able to attend to my professional duties without the 
slightest inconvenience. 

The character of this disease was so new to us, that we were 
entirely unprepared to anticipate its rapid progress — its mode 
of attack varying in almost every case. We were likewise 
ignorant of what the next twelve or twenty-four hours would 
unfold. Trusting to general principles was at best but a slim 
guide. We could not determine a priori; therefore some ex- 
tenuation will be allowed — a inferiori. We can look through 
the past, and see our errors. I can now see that bleeding would 
have been pernicious — it must have been so. Even cupping, 
when the patients would not bear the slightest purgative with- 
out a manifest tendency downwards. Stimulants, alone, could 

1853.] Preston, on Malignant Spotted Fever. 337 

not be relied on ; sinapisms down the spine were beneficial : 
and, above all, opium in full and free doses — Wherefore? 
Whatever may be the poison which operated with so much 
power and certainty, its primary effects must have been through 
the medium of the blood, directly upon the organic nervous 
system. The three great nervous divisions — the Motory, Sen- 
sory and Respiratory — were the last to experience its effects; 
but those concerned in (he office of reproduction and depura- 
tion were the first to fail. The tissues and capillaries lost their 
normal rythm. The desire for fluids was intolerable, and the 
more it was indulged, the greater was the thirst. Vomiting 
occurred in all the fatal cases, resulting, no doubt, from cere- 
bral disturbance. The period of reaction, instead of being 
followed by a benign sweat, was terminated by congestion. 
The congestion was evidently of two kinds — one sanguineous, 
and the other serous. I know not whether this distinction has 
befcn made by writers: I shall, however, venture upon its 
adoption, and account for it accordingly. When the organic 
nervous system has lost its tone partially, semi reaction fol- 
lows. The capillary system being already weakened, is unable 
to bear the tension required for the increased volume of blood r 
it is nevertheless injected, and during its passage the tissues 
transmit the smaller globules of serum through their walls. A 
removal still farther, and the organic nerves cease to supply 
elasticity, and we have, together with serum, the red globules 
or coloring matter of the blood ; from whence issue infiltration, 
especially in the lungs — a mechanism of exquisite capillary 
formation. The inflammation was asthenic, and that in pro- 
portion to the gravity of the disease. Whenever a septic 
influence operates upon an individual, the phenomena will be 
proportionate to its power and susceptibility. 

Permit me, whilst with timidity I call your attention to a 
class of diseases, little understood, which sweeps off, annually,, 
thousands of our citizens. I do this with a view to elicit from 
the profession that information which every Southern practi- 
tioner ought to have, and no doubt desires. 

For many years, during my first practice, I heard of Bilious 
Pneumonia and Typhoid Pneumonia committing great havoc 
in certain districts of this State. I must confess I was at a loss 

338 Preston, on Malignant Spotted Fever. [June, 

to understand how these diseases could kill in the short space 
of one or two days. These terms, I find, are used for any vio- 
lent disease, either of the brain or lungs. All means generally 
proved abortive ; and physicians, skilful in the treatment of 
other diseases, were, and are (the majority) totally unprepared 
to form a platform on which they might rely for a guide. It is 
the prevailing opinion, that each season has its simple type of 
disease, and that these types generally follow in regular order, 
is granted to some extent. There is a constitutional cycle, 
continually changing our atmosphere, producing thereby a 
dysentery, amenable to purgatives one year, to tonics another, 
and to astringents, alteratives, &c. This is the pregnant source 
of Doctors disagreeing. Medicine is a science — a pure sci- 
ence ; but vastly more complex than all others. When we 
look through the lists of our venerable fathers' times, ought we 
to throw all their learning aside, and lay their experience upon 
the shelf. Through their records we learn the ever-varying 
faith in remedies. For a season, one drug has proved unvary- 
ing in its remedial qualities — it has borne the title of specific* 
and bothered to gainsay. Anon, it falls into other hands, and 
times, and is found useless — aye, inert. 

We are startled by the conviction that coincidences have 
had so much to do in the matter. In the science of Quantity, 
men do not vary so widely from the truth. From one to a 
thousand start in the demonstration of a mathematical problem, 
and arrive at the same conclusion. But place these same men 
upon the demonstration of a problem in Quality — their conclu- 
sions are not alike. Wherefore ? The bases are all different : 
Climate — the physical qualities of soil — moral and hygienic 
influences are equally opposite. In the annual and periodic 
evolutions of atmospheric and aqueous conditions, no two sea- 
sons are precisely alike. At one time we have an easy road 
to travel, when referring to authors for our guide in the treat- 
ment of disease — we are chained by the lucid and exact detail. 
But again we are foiled when trusting to the same source. 
To illustrate: The exanthemas, especially those commonly 
known by the name of measles, scarlatina, &c, have had their 
specifics; and well might they, when yielding, from the simpli- 
city of their type, to almost any remedy, right or wrong. The 

1853.] Preston, on Malignant Spotted Fever. 339 

very simplest of all combinations were then prevailing — hence 
the benign inflammatory action. 

We are told in the books, that inflammation is manifested by 
certain signs and terminations ; that an incised wound heals 
by the first intention, &c. True, so far as they go. But there 
is one department which has not been properly investigated — 
viz., the constitutional combinations, which may convert this 
simple inflammation into the more complex varieties. A cause 
sufficient to produce inflammation of the viscera in London, 
Stockholm, &c., may give rise to the phenomena recognised 
in those places ; but when superadded to this, we have an indi- 
vidual exposed to the above, with a powerful concentration of 
malaria, in a malarious district, and his system saturated with 
the latter, it would be marvellous did we recognize the same 
symptoms as in the former. 

To add force to my deductions, I will here call your mind 
to the fact of erysipelas prevailing as an epidemic in the wards 
of hospitals. Let us now take an individual who has suffered 
the simplest wound in a pure atmosphere, and there allow the 
healing process to be partially completed — carry him from 
thence to the infected ward, and the same wound is converted 
into one of a much more serious character: it is erysipelatous. 
Again, under analogous circumstances, let us carry a case of 
pneumonia into wards where malignant typhus prevails, will 
it not become typhoid pneumonia. By a parity of reasoning, 
I will now refer you to those seasons when bilious and typhoid 
pneumonia, together with asthenic inflammations, prevail. We 
are too apt to consider that, upon the general disappearance 
of intermittents and remittents, after frost, the malaria which 
produced these diseases is also abolished therewith. A know- 
ledge of facts will convince us to the contrary, especially when 
we are credibly informed by the Swedish physicians that inter- 
mittents prevail so high as the latitude of 62° North. Now 
it must be evident that our thermometer will stand as high T 
and higher, in manv of our winter days, as in the Northern 
parts of Sweden. In our locality, a physician of ordinary skill, 
and the plainest routine, succeeds in curing every case of pneu- 
monia. All that he has to do is to give his patients a little 
soup and antimony, and the lucky dogs get well. Step a few 

340 Preston, on Malignant Spotted Fever. [June, 

miles farther, and your learned Doctor — your theorist, is mor- 
tified by his signal failures. Can it be possible that, as a gen- 
eral rule, antimony, given under precisely similar circumstances 
in the same disease, should fail in the hands of the learned in 
twenty cases — whereas it certainly succeeds in the hands of 
the ignorant practitioner in a like number ? Certainly it would 
be the greatest absurdity to deem it true. I will, in my mind, 
offer you a more rational ground for the discrepancies which 
are so constantly witnessed. When the variations in tempera- 
ture alternate with great changes from low to high, and that 
in a country where intermittents, &c, are endemic, we shall 
witness corresponding changes in the type of disease. When 
an individual whose system is saturated with a malaria capable 
of producing a benign quotidian, tertian, or quartian, or a ma- 
lignant quotidian, &c, and he is moreover laboring under the 
exciting causes of pneumonia, phrenitis, &c, we shall not wit- 
ness phenomena such as result from the above named diseases 
separately ; instead thereof, will be found the types blended 
together — to wit: a congestion, or cerebro-spinal meningitis, 
coupled with pneumonia in its simple form. Again, there may 
be pneumonia associated with gastritis, or gastro-enteritis, 
together with hepatic derangement, giving rise to the common 
phraseology — complicated pneumonia, congestive pneumonia, 
congestive bronchitis. As a proof of this fact, we have only 
to treat any of the above forms for simple pneumonia, or the 
like, and we very soon find we have to change our course or 
give up the ship. Let us now remove the complication, by 
setting aside the one which most readily yields — to wit : the 
intermittent, with quinine, opium, &c, and if thereafter is 
found a pneumonia, it will yield to the ordinary remedies when 
judiciously administered ; or if you please to let it alone, it will 
in many instances get well of itself; but this is trusting too 
much to nature, and giving the chance to the umpire of matter. 
Again, whenever the malarial influence is so strong as to pros- 
trate the organic nervous system, and associated therewith 
inflammation of any organ, there will be asthenic inflammation 
instead of the sthenic. 

Let us now, in another season, have diseases of a typhoid 
type associated with a malarial influence — they will be respec- 
tively still more complex and vastly more rapid. 

1853.] Preston, on Malignant Spotted Fever. 341 

Shall it be Dysentery, thus characterized, prevailing as an 
endemic, or epidemic? How sorely puzzling will be its 
forms! — how devastating its influence ! ! 

Have we not seen the Algid typhus in the negro, with his 
cold icy body ; and when asked how he is, have we not heard, 
and despaired, from the laconic answer — "better!" But out- 
wardly we behold marasmus, sure and steady as clock work. 
Thirst, there is none ; appetite none ; instincts are almost abol- 
ished, together with the moral and physical impulses. Pros- 
trate he lies upon his back, more careless than incapable of 
motion — intellect torpid, but when roused, clear. There is 
profound apathy, with alternate transitions to the quotidian, 
tertian or quartan types. Thus do we see the crises of the 7th, 
14th, 21 st and 28th days; and by marking the periods (odd or 
even days) when the patients are better or worse, we may 
with more certainty base our prognosis. 

It has been our lot, within the last three months, to be visited 
by that peculiar form of inflammation which has swept off 
thirty or more of our citizens, within the space of from three to 
forty-eight hours, and that within a radius of seven miles. By 
some, the disease was called Typhoid Pneumonia — by others, 
Bilious Pneumonia. But, in fact, it has been in some an asthe- 
nic inflammation of the bronchi — and in others, of the lun^s, 
brain and pharynx. The sanguine, robust, and plethoric, who 
were susceptible of malarial influences, were mainly its vic- 
tims. When the disease was of a concentrated form, or fully 
developed, purgatives, if not inoperative, were sure to aggra- 
vate. Again, a class of apparently the same disease yielded 
immediately to the influence of senna, manna and salts. It was 
astonishing to see how rapidly the integuments, beneath the 
eye and upon one side of the face, would become suffused with 
dark coagulated blood. One case I shall briefly notice. 

Rogers, a boy, 9 years of age, previously healthy, possess- 
ing a fine sanguine temperament — was taken in February, at 
midnight, with slight indisposition. In the morning, 8 o'clock, 
there was still but little ailment — was disposed to be drowsy j 
face flushed, not much; pulse 90, compressible. Gave senna, 
manna and ginger tea, together with quin. sulph. and hyd. sub. 
m. When seen next morning all the unpleasant symptoms had 

N. S. VOL. IX. NO. VI. 22 

342 Preston, on Malignant Spotted Fever. [June, 

vanished ; beneath the right eye there was a bruised appear- 
ance the size of a dollar- The conjunctiva at first was injected, 
but had disappeared. 

During the last two or three years there has been typhoid 
fever associated with intermittens, and for the last five months 
the mortality in our section has vastly increased. Carbuncles 
and melanosis have been no strangers. 

Now, whatever has been the influence which has produced 
so many malignant features, of this one effect we are certain ; 
that we have, in many instances, to deal with an intense asthe- 
nic inflammation, which speedily terminates in effusion or in 
sanguineous infiltration. During the last two months of the 
last fall, almost ail of our intermittent^ were double tertians, 
and the greater proportion of these were malignants — instead 
of postponed,, they were anticipated double tertian. In some, 
there was a marked semi-reaction, very difficult to determine — 
in others,, a combination of typhoid and congestive symptoms. 
Again, the pure algid and congestive varieties. Now, we 
have had nearly all of the above forms in the present spotted 

It would afford me pleasure to continue this subject. Least 
I weary your patience, I will briefly allude to the character of 
inflammation. , 

There is no doubt that we have been altogether remiss in 
our investigations with regard to this disturbing force. Dis- 
:urbing, I call it — for on the one part, nature may be too ener- 
getic in restoring an equilibrium; on the other, she maybe 
altogether deficient. In the former, we have the simple benign 
plastic qualities of an over excited sanguiferous system, in which 
the potent lancet is truly, and beyond all doubt, the omnis omne. 
But, in the latter the vis vitse no longer yields the plastic- 
lymph* Let us now marshal our forces, as in the above, and 
what do we behold: an account soon settled — a patient ia 
articulo mortis* 


Rossignol's Statistics of Mortality. 



Statistics of Mortality in Augusta, Georgia, during the years 
1848, '49, '50, '51 and 52. Arranged by H. Rossignol, M.D., 
of Augusta. 

The following Tables have been made from the books of the 
City Sexton, and may be relied upon as to numbers ; but as 
relates to ages and the immediate causes of death, I will not 
vouch for their correctness, as I noticed some errors in these 
respects in looking over the books. 

Similar tables having been published in this Journal in the 
1st volume (old series), p. 650 — the 3d vol. (old series), p. 048, 
and the 4th vol. (new series), p. G58, it will be seen that these, 
when added to them, will complete the vital Statistics of the 
City of Augusta for a period of thirty-five years, and that they 
•contain valuable information, notwithstanding the inaccuracies 
alluded to. 

Table No. 1. 
Census of Augusta, taken by order of the City Council, October, 1852. 







Males I Females 
between between 
Hand lfi 6 and 15 








243 2330 2388 11,753 

Transient or temporary residents — white 400 

Free Negroes and Slaves, not returned ■.. 400 

Business and Suburb population ■. .*..,, 1,510 



Table No. 2. — Deaths in each year. 

In preparing this table, the still-born are included, as it was 
deemed unnecessary to make a separate table for thetn. 

















• 1851 






1 147. 



Rossignol's Statistics of Mortality. 


Table No. 3. 
Deaths in each month — the Still-born included. 


















-3 * 





















j lb51. 







9 ! 13 







7 14 









































A ugust, 

















































































16 26 

















































































Rossignol's Statistics of Mortality. 


Table No. 4. 
Number of deaths in each month, during a period of five 
years, with averages deduced from the column of whites, from 
that of blacks, and from the total. 






































J 33 































18 04 







30 00 





13 80 

12 20 






13 80 



Table No. 5. 
Average number of deaths per annum, during five year 
among the whites and blacks, at different ages. 







Under 5 years, 



5 years, 


From 5 to 10 years, 



5 to 10 years, 


" 10 to 20 " 



10 to 20 " 


" 20 to 30 " 



20 to 30 " 


" 30 to 40 " 



30 to 40 " 


" 40 to 50 " 



40 to 50 '• 


" 50 to 60 " 



50 to 60 " 


" 60 to 70 " 



60 to 70 " 


" 70 to 80 " 



70 to 80 " 


Over 80 years, 



80 years, 


It will be observed, in the above table, that a much larger 
number of blacks are put down as living beyond SO years, than 
whiles. This can easily be accounted for by the well known 
fact, that negroes, generaliy, are ignorant of their age, and are 
particularly fond of living to a "good old age," which they 
affect by adding on as many years as suits their taste. 


Rossignol's Statistics of Mortality, 



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Rossignol's Statistics of Mortality. 


Table No. 7. 
Causes of Death, as recorded by the City Sexton. 

Very little, if any reliance, can be placed on this table, as the 
Sexton rarely derived his information from those who were 
•capable of giving it. In making this table it was thought best 
to give the names of the diseases as found recorded, without 
any attempt at classification, as that would have been an end- 
less undertaking. 



























































Old Age, 

























Brain Fever, 























Cholera Infantum, 










Affections of Lungs, 








































Affections of Liver, 

















Fits, Spasms & Cramps, 














Inflamed Bowels, 












































• 3 












Typhoid Fever, 



















[Continued on next page.] 


Rossignol's Statistics of Mortality. 


Table No. 7 

, (conclu 







































Dropsy of Brain, 




Inflammation of Brain, 









Scarlet Fever, 


















Ulcerated Sore Throat, 








Congestive Fever, 





Congestion of Brain, 






Dropsy of Chest, 








































Disease of Heart, 













Invag'tion of Bowels, 




Diseases unknown, 











Disease^ stated, 











1 Whole No. of Deaths, 











Table No. 8. 
Relative proportion of the Sexes of those who died. 

















































































1853.] Ricord's Letters on Syphilis. 349 

(Eclectic Department. 

Letters upon Syphilis. Addressed to the Editor of L'Union 
Medicale, by P. Ricord. Translated from the French, by 
D. D. Slade, M. D. 

[Continued from Page 278.] 


My Dear Friend— Does there exist any real difference 
between the natural and the artificial contagion ? This is the 
subject of our conference. 

The observation and rigorous analysis of facts demonstrate 
to those who do not suffer themselves to be led away either by 
prejudice, or by preconceived ideas, that the contagion of 
syphilis, under whatever circumstance it may operate, is re- 
duced in the final analysis to a process of inoculation more or 
less analogous to the process by the lancet. The lancet, in fact, 
inoculates the accident (the chancre) which by the confession 
of all is the most fatally contagious. It is by this accident, by 
the chancre, according to observations well made and collected 
in the proper time, that syphilis commences. 

Laying aside artificial inoculation, the chancre is seen to 
develope itself everywhere upon the surface of the body without 
choice of seat, and upon all the external or internal integument, 
which is accessible, and by consequence, without there being 
need either for the parts which are infected, or for those which 
furnish the infecting matter, of special functions or of any par- 
ticular physiological condition. Other conditions are neces- 
sary for contagion. 

Examine with care all the parts which are affected, you will 
find that it is those which present the most favorable condi- 
tions for mechanical lesions, for scratches, for lacerations, and 
for solutions of continuity of every kind ; you will find, also, that 
it is there where voluminous and numerous follicles exist into 
which the virulent matter can introduce itself, that the accident 
is by preference developed. 

Is it not true that in the male it is more particularly the 
border of the prepuce, especially when there is a phymosis 
more or less pronounced, the neighborhood of the frasnum, the 
adherent points of the semi-mucous surface of the gland and of 
the prepuce, points which not Laving the suppleness of other 
regions are more easily torn, that by preference become infec- 
ted by the contagion ; in the female the fourchette, the points of 
insertion of the nymphae, the carunculae myrtiformes, are the 
parts which most easily take on the contagion. In the other re- 
gions, is it not true that it is when excoriations exist that the 

350 Ricord's Letters on Syphilis. [June, 

contagion is established? Thus, an excoriation upon the finger 
is often the door where syphilis can enter. But the presence 
of an excoriation is absolutely indispensable. If it was other- 
wise, should I ever go out of the hospital without having a 
chancre at the end of each of mv ten fingers? The chancre 
often appears upon the lips, but the lips are almost always 
cracked ; pleasure excites the smiles, and smiling extends and 
dilates the lips. The nipples of nurses are often the seat of 
chancre, but these parts are ordinarily cracked and torn. The 
chancre seats itself everywhere w 7 here there has been a cica- 
trice, but there also there is a loss of suppleness, and conse- 
quently cracks and lacerations are easy. 

In all this, my friend, you see nothing which is, as they say, 
physiogical, which exacts special vital conditions, a particular 
state of organism and the exercise of any function whatsoever. 
All this, for you, as for myself, is reduced to a traumatic and 
and mechanical phenomenon. 

Practice, that criterion of all doctrines, justifies, alas, too often 
my doctrine. Nothing is more common than to see the physi- 
ological act of generation rest indemnified from every unhappy 
consequence, while other acts which have nothing in them 
physiological, draw after them painful results. The genital 
organs, the seat so special of syphilitic affections, do not always 
take the infection from genital organs. It is not always the 
genital act properly called, which becomes the infecting cause. 
Coitus does not become an infecting act unless certain material 
circumstances come into play. Among the innumerable ex- 
amples which I could cite for the support of my opinion, 1 ask 
permission to cite to you two, which have struck me more, inas- 
much as they presented themselves to me suddenly upon the 
same day. There is no physician who does not know that 
there are some singular days, when curious facts arrive as if in 

A gentleman brought me one day his mistress, whom he had 
infected, and in a manner which much astonished him. He had 
upon the penis a primary ulcer at the period of specific 
progress. He had had normal intercourse with his mistress, 
and in the same night intercourse more to be blamed, a prepos- 
tera venere. The lawful intercourse had been much more fre- 
quent than the other. The woman presented absolutely 
nothing suspicious upon the genital organs, but she had a 
chancre on the anus. What did this mean? That the physi- 
ological and natural passages had yielded without laceration, 
and had escaped contagion, while the abnormal passages, more 
resisting, were torn and became infected. 

Here is another couple. Here, again, is a contest between a 

1853.] Ricord's Letters on Syphilis. 351 

physiological act, and a prelude which does not belong to the 
human species, a prelude which is not at least placed among the 
genital functions of man. A gentleman surprised at seeing a 
suspicious bud pushing forth upon one of his lips (bud without a 
flower, as Jean Lemaire would have called it,) without any 
disease of the genital organs, comes to ask me to examine the 
woman with whom he had had intercourse. I found upon this 
woman a chancre at the specific period, situated in the neigh- 
borhood of the meatus urinarius. This gentleman had had 
rather frequent sexual intercourse with this woman during the 
same night, during which he had gone astray so far as to sadly 
expose his lips. It is necessary to add that this gentleman 
was very subject to chapped lips, and that all this passed in 

These facts, which I could multiply, prove that the physiolo- 
gical conditions of the genital act go for nothing in the conta- 
gion of syphilis. Thus the doctrine of physiologism finishes 
upon this point by falling to the ground. Be well convinced, 
that in spite of the most intimate contact, of the most complete 
fusion, and of the orgasm the most voluptuous, with an entire 
skin and an irreproachable mucous surface, one can escape safe 
and sound from the most exposed intercourse. Be assured on 
the contrary, that a portion of skin torn, a mucous surface chafed, 
will render the slightest intercourse dangerous, and we physi- 
cians have a thousand precautions to take in this respect, and 
certainly our examinations are strict. We know, however, 
that the medical corps has furnished victims to the martyrology 
of syphilis, and that it was in the beneficent exercise of our art 
that the unfortunate Hourmann, and Delavacherie of Liege, 
found a death tediously frightful. 

After what I have just toid you, what can you think of the 
pretended physiological inoculation of my colleague M. Vidal, 
as regards blennorrhagia ? You know when and how this 
latter is really inoculated by the lancet. It is then, and only 
then, when it proceeds from a chancre, and it is the rarest 
case, as M. Vidal agrees with me. But in other conditions in 
which blennorrhagia is produced, is there, physiologically and 
pathologically speaking, anything which resembles the conta- 
gion of chancre ? Do we even always know, as I have said, till 
tried, if the blennorrhagia is always due to a veritable conta- 
gion ? And yet this condition of contagion has been considered 
as a proof of virulence, as a sort of physiological inoculation, 
which the lancet cannot produce. Here M. Baumes — it would 
seem that the successive contagions of blennorrhagia were his 
means of diagnosis, without telling us, nevertheless, how many 
times blennorrhagia ought to be produced in order to be 

352 Ricord's Letters on Syphilis. [June, 

virulent. Thusone tnkes a blennorrhagia, he gives it toanother, 
where commences the virulence? M. Baumes does not say. 
Suppose that a woman is suspected of having contracted a dis- 
charge from a suspicious man — if we should wish to assure 
ourselves upon the nature of the discharge of this woman, it 
would be necessary to hold an inquest, to run after the ditferent 
sources of the blennorrhagia of the man, and to pursue it, going 
back even to the gonorrhceal flux of the Bible. Yes, hut we 
should not have made one step in this inquiry, without finding 
ourselves in the presence of that most common difficulty, of two 
individuals having had commerce with the same woman, the 
one will have contracted a blennorrhagia, and the other not. 
For one, we should conclude upon the benignity of the blennorr- 
hagia, and for the other upon its virulence. All this is not 

Facts and observation, then, do not indicate any difference, 
my friend, between the inoculation called physiological and the 
artificial. Let us now invoke analogy. 

In every malady incontestably contagious we find that the 
traumatic conditions dominate, and that under ordinary circum- 
stances art can repeat what nature does. Thus the vaccine 
inoculated does not differ from ordinary vaccine. The variola 
inoculated does not differ from the spontaneous variola. Thus 
with the glanders, the farcy, hydrophobia, malignant pustule, 
and hospital gangrene. This argument from analogy appears 
to me of incontestable value. Why should the syphilitic virus 
alone escape from the common rule ? 

But the chancre, it has been said, is not the only contagious 
syphilitic accident. There are some secondary syphilitic acci- 
dents for which the lancet has not yet discovered the contagium. 
Science, in fact, contains a great number of observations which 
appear conclusive for a very large number of physicians, and 
which leave some doubt in the minds of many others. The 
numerous tubercles, or condylomata, are considered by a very 
large number of writers upon syphilis as contagious, and by 
consequence can be transmitted. 

When I have studied this accident by means of inoculation, 
considering well all the circumstances which could prevent 
error, the experiments have always been negative. However, 
other observers have obtained contrary results. I can only 
answer for this exception by stating the result of my own ex- 

I inoculated with the pus of numerous tubercles coming from 
the neighborhood of the vulva of a young girl of Versailles, who 
entertained habitual intercourse with the garrison of the place, 
and I obtained a positive result. Much astonished, I examined 

1853.] Ricord's Letters on Sypkilis. 353 

with more care the surfaces from which I had taken the pus, 
and it was then easy for me to recognize that among the nu- 
merous tubercles, there existed a chancre still at the period of 
specific progress. Then, some new inoculations being made 
comparatively with the pus taken upon this ulceration, and with 
the matter of the mucous tubercles at a distance, the pus of the 
chancre gave ihe characteristic pustule, and the muco-purulent 
secretion of the mucous tubercles remained without result. 
This experiment appeared to me decisive. 

In the observations which have been cited of mucous tuber- 
cles which have communicated syphilitic accidents — the period 
which has passed between the time of observing the patient and 
the infecting coitus has not been taken into account. It is 
always three weeks, a month, two months or even more after 
the contagion, that the patients present themselves to the physi- 
cian, so that not only the renl form of the commencement is 
wanting, but still it is impossible to determine the true nature 
of the accident which has been the source of the contagion. 
Some individuals forget, and others do not know, that by a suc- 
cession of changes easy to observe, where one takes the pains, 
the primitive accident (the chancre) passes in situ from the state 
of an organ of virulence to the conditions of a secondary acci- 
dent, not furnishing any more specific pus. Where are the 
observations of persons seen with mucous tubercles, who have 
transmitted the disease to another person which could be 
observed the second or third day after the infecting coitus, and 
in whom the disease has commenced as we see it commence 
after the contagion from a chancre ? Does the disease in this 
case commence with the chancre, or with the mucous tubercle? 
There is not one single incontestable fact which can answer 
this question. The facts, however, do not fail as regards 
mucous tubercles. As to myself, I possess very numerous ob- 
servations of well-characterized mucous tubercles upon men 
and women, which prove that the patients thus affected could 
indulge in frequent sexual intercourse without communicating 
anything. Among all these facts here is one, my friend, which 
will remain deeply impressed in the minds of my readers, as it 
has in my own. 

A gentleman whom I had attended for a chancre two )ears 
before, was about to marry.. Before his marriage he came to 
see me again, in order to submit himself to a rigorous examina- 
tion. I found him in the best state of health ; he could be 
married without any scruples. However, this gentleman, a 
very strict man, exacted of me another examination the very 
evening of his marriage. I still found him perfectly exempt 
from every accident, and I delivered to him my bill of health 

354 Ricord's Letters on Syphilis. [June, 

as clean as possible. One month after, he sent for me. My 
dear doctor, he said, my wife has some large pimples upon her 
which troubles her very much. See what it can be. Before 
passing into the chamber of the wife, I proceeded to a new ex- 
amination of the husband. I found him in as healthy a state as 
the day of his nuptials-. 

But it was not the same with his wife. I found some conflu- 
ent and well-developed mucous tubercles, so as to assure me 
that the point of departure of the accidents was anterior to the 

Convinced that the husband had nothing to do with this sad 
affair, and that he could not communicate a disease he did not 
have, I said to the wife in a firm and decided tone — Madam, you 
are diseased, and it is not your husband that has rendered you 
so. If I become your confidant, I become also your accom- 
plice ; in the contrary case, I shall remain the physician of your 
husband. I was not long in obtaining a painful confession, 
which gave me the key to this unhappy enigma. 

I recount to you this fact because it contains this which is 
interesting, viz., that since marriage the husband had not passed 
two days without having repeated intercourse with his wife, 
and notwithstanding, he had absolutely no disease. 

I have not finished with the mucous tubercles; permit me to 
return to them in my next letter. 


My Dear Friend, — I return to the mucous tubercle. As 5*011 
know, this accident, with many writers upon syphilis, is conta- 
gious. Among the proofs invoked for the support of this opin- 
ion, we must note that which considers as a result of contagion 
the successive development of these mucous tubercles upon 
those portions of the skin which are contiguous to those where 
the accident first developed itself. Thus, patients are seen 
who have these mucous tubercles upon the sides of the scrotum. 
Do they develope themselves upon the inner portion of the 
thighs — contagion ! cry out the partisans of this opinion. If 
upon one side of the anus these tubercles gain the opposite 
side — contagion ! they again cry, and so on. Those of my 
brethren who profess this doctrine, and there are among them 
some very distinguished ones, forget one little circumstance ; 
to hold in consideration the cause which has produced the first 
tubercles ; that is to say, the state of the constitutional infection 
under which the patient labors, a condition which can cause a 
second and a third tubercle to put forth, for they do not a?I 
appear at the same time. The consideration of the seat of 

1853.] Ricord's Letters on Syphilis. 355 

preference of these tubercles cannot in any way aid the doc- 
trine of contagion; in fact, if there is a contiguity in the parts 
of the skin where these tubercles appear, we must also remark 
that the acrid secretions are more active : that the skin, in these 
places, has a tendency to the mucous transformation, as in the 
neighborhood of the genital organs, of the anus, &c. How can 
we explain, moreover, by contagion, the development of these 
mucous tubercles from one arm-pit to the other? 

I shall remain, then, always' convinced, until proof to the 
contrary arrives, that when some have thought to have seen 
mucous tubercles contagious, while they have admitted that 
they could be primary accidents, they have erred in diagnosis. 
I do not think*it useless to call to mind that the chancre, at the 
period of reparation, often assumes, in granulating, the aspect 
of mucous tubercles, that it can undergo sometimes a veritable 
metamorphosis, and become in situ a secondary accident, the 
physiognomy and the nature of which are those of mucous tu- 
bercles. If we have not been witnesses of its commencement, 
if we neglect to invoke the testimony of the neighboring glands, 
the remains of the margin of the ulcer and the characters of its 
base could have been so modified, that the differential diagnosis 
would be very difficult to make, especially for inattentive eyes 
and for fingers little skilled. Add to this certain particular seats 
where the primary accidents are not usually observed, and 
where also the transformation of the chancre is more easy, and 
more rapid, as upon the lips, upon the tongue, upon the nipples, 
and you will see how easy it is to be deceived. 

All those veroles, transmitted by kisses more or less lascivious 
by the utensils of the table, by pipes, razors, masks, &c. have 
no other origin. And how many times have not these circum- 
stances been honest pretexts for dissimulating other contracts f 
The mask, moreover, has been from all time, and in our day 
still a very convenient article for dissimulating a compromising 

Even in certain religious practices, my friend, they have 
sought proofs of secondary contagion ; thus they have arranged 
in this category the syphilitic accidents transmitted to infants 
by the process of the Hebrew circumcision. But these acci- 
dents find their natural explanation in the presence of the pri- 
mary accidents in the mouth of the circumcisers. Let me 
here be permitted to say that I am one of those w r ho have most 
contributed to cause the ancient and dangerous practice of the 
suction to be rejected by the Israelite Consistoire of Paris. 

Many physicians will not absolutely take into consideration 
the facility with which the chancre passes into the secondary 
state ; they occupy themselves only with its seat ; and when 

356 Ricord's Letters on Syphilis. [June, 

they see a chancre in the mouth, they are induced to consider 
it, from this fact alone, as a secondary accident. Herein lies a 
grave error of observation ; this gives me occasion to say that 
the primary ulcers become much more frequent in the mouth 
than in the anus. I meet with these last much less frequently, 
both in the hospital and in the city, than formerly. It appears 
to me that certain shameful practices diminish in frequency, 
and that there is progress in ihis respect in the public morality. 
However it may be, from the fact alone that a chancre is seated 
in the mouth, don't conclude that it is a secondary ulcer. Do 
not forget the famous genito-labial nerve invented by Voltaire, 
a spiritual pleasantry which must be sometimes considered as 
serious. I know a very distinguished brother physician, who 
lias always remained convinced without other proof, that an 
ulcer of the cheek had been communicated to him by a seconda- 
ry kiss. 

If I have told you that I have often seen persons affected 
with different varieties of mucous tubercles upon the genital 
organs, who transmitted nothing in their sexual intercourse, I 
ought to tell you. also, that I have seen an equally large number 
with numerous tubercles upon the lips, upon the tongue, and 
upon the throat, who lived in family and who practised all the 
buccal contracts permitted, without ever transmitting anything. 
I know a gentleman of the neighboihood of Paris who had 
during six months, numerous tubercles upon the tongue and 
upon the lips, who has had with his mistress all possible inter- 
course, very negligent about his treatment, and who, convinced 
that the accidents which he had could not be contagious, has 
continued his intercourse without ever communicating any- 

It is, moreover, as regards the transmissibility of these se- 
condary accidents from the nurse to the child, and viceversd, 
that this question becomes important. The fact of this trans- 
missibility is generally admitted. Hunter has, however, denied 
it, and many serious observers partake of the opinion of Hunter. 
This question is so important that you should permit me to give 
it some development. It concerns public hygiene. It is often 
a question of legal medicine; fraud, infidelity, cupidity, can be 
brought into action: it is important, then, to guard against all 
the causes of error, and not to accept with readiness the stories 
of individuals who could have more or less interest in deceiv- 
ing us. 

If one consults the archives of science, if one searches for 
the basis upon which the opinion of the contagion of secondary 
accidents of syphilis from the nurse to the child, and recipro- 
cally, rests, he is astonished at the little value of facts, and how 

1853.] Ricord's Letters on Syphilis. 357 

manv grave men there are who are content with liitle. M. 
Bouehert, for example, in a memoir reeentl)' published (Gazette 
Medicale, 20 Avril, 1850.) has collected all the facts which 
have appeared to him the most positive. Well ! read this hook, 
interesting in other respects, and you will he convinced, like 
myself, that the greater part of these facts are not admissible, 
that the observations which appear the most probable are 
wanting in essential details, and are so incomplete that M. 
Bouehert is himself' forced to confess it, to such a degree that he 
finishes by allowing that his conviction upon this point is more 
moral than scientific. 

Here is what I myself have observed in this matter. 

I have seen nurses and infants infected, who have been mu- 
tually accused of this infection ; most generally I have succeed- 
ed in rinding the point of departure, regular and inevitable, 
going back to a primary accident in one or the other. Some- 
times I have met with merely simple coincidences. In those 
cases where it has not been possible for me to go back to the 
primary cause. I arrive too late; the children were not present- 
ed to me till five and six months or more after their being put 
to nurse. I have had, during several years, a ward of nurses at 
the Hospital du Midi. In this ward, I had often women affected 
with simple leucorrhcea, to whom I gave to nurse children sent 
to me from the Maternite, infected with secondary accidents, 
and never under my observation were these women infected. 

On the other hand, nurses affected with very manifest secon- 
dary accidents have given the breast to infants sent to me as 
infected with syphilis, these latter having in reality nothing but 
simple eczematous, impeteginous eruptions, or species of porri- 
go, and never under my observation were these infants infect- 
ed. My learned and industrious friend, Dr. Nonat, charged 
during a long time with the care of the nurses dependent upon 
the administration of hospitals, has arrived at the same results, 
and does not believe in the contagion of secondary accidents 
from nurses to children, and vice versa. 

In my private practice I have seen a great number of facts 
of this kind. Here is one of the most remarkable, which I 
observed together with my friend Dr. Chailly-Honore. The 
subject of it was an infant born with hereditarv syphilis, and in 
whom six weeks alter birth, various accidents made their ap- 
pearance, such as mucous tubercles of the ano-genital regions, 
humid scaly papulae upon the trunk and upon the limbs, deep 
ulcerations upon the lower lip. This infant was given to a 
nurse upon the spot at the moment of its birth. We were able, 
both M. Chaill v and myself, to observe the child as well as the 
nurse, during the eighteen months that the nursing continued. 

n. s. — VOL. IX. no. vi. 23 

358 Ricord's Letters on Syphilis. [June, 

The ulceration of the lip persisted during more than three 
months. This was scarcely cured, when in spite of a careful 
methodical and continued treatment, a new ulceration manifest- 
ed itself upon the velum palati, and resisted also during several 
months. Well, this nurse remained free from all infection ; she 
enjoyed and enjoys still the most perfect health. 

Surely, this is a fact well worthy of attention. I have just 
observed an analogous one, with my friend M. Bassereau. A 
child who, with other symptoms of hereditary syphilis, had 
ulcerations upon the lips, was nursed with entire impunity by 
its nurse. 

You see my friend, how important it is, in the appreciation of 
similar facts, to hold in consideration all the conditions in which 
the nurse and child could be, if one did not wish to deceive or 
to be deceived. 

The nurse, at the moment when she takes an infant, might 
be under the influence of a syphilitic diathesis which nothing 
yet indicates. 1 ought to say that in general when one takes 
a nurse, she is not submitted to a complete and absolute exam- 
ination. I add that even when this is done, we could still be 
deceived, for the diathesis cguld exist when every trace of prim- 
itive or secondary accident had disappeared, especially in such 
a case as chancre upon the neck of the uterus. I ought still to- 
add that the health of the foster-father is not always, alas! a 
sufficient guarantee. I have known for a long time how I 
should consider the pastoral maxims upon the pure manners of 
the country. 

The child might be born with hereditary syphilis ; child and 
nurse have nothing as yet apparent ; but in some weeks or 
months we shall see secondary symptoms manifest themselves. 
These might appear in the infant before, during or after a similar 
manifestation in the nurse. So- that the first in whom the man- 
ifestation shall take place, will accuse the other, if they do not 
both accuse each other at the same time, which frequently 
occurs. They are both wrong. There is a simultaneousness, 
a coincidence, and with attention and patience we shall succeed 
in discovering the truth. 

It happens sometimes that nurses contract syphilis during 
nursing:, and the contagion can have its influence upon them 
through different regions. Most frequently it is by the genital 
organs. This fact is not uncommon for nurses who come fre- 
quently to Paris. Under these conditions the nurses infect their 
infants by the aid of their fingers contaminated by the virus. 
Thev infect even their husbands, and in these cases the cause 
of the evil is always referred to the Parisian child — to those 
rotten children, as these unchaste nurses are in the habit of 

1853.] RicoroVs Letters on Syphilis. 359 

saying. It happens very often to M. Cullerier and myself to 
make our observations simultaneously in our two hospitals ; he 
attends the woman at the Lourcine, and I attend the husband 
at the Hospital du Midi. These poor rustic husbands besides 
have an extreme candor upon the origin of their verole. The 
infant is invariably for them the origin of all the evil. 

A mode of contagion quite common with nurses is the inoc- 
ulation of the virus which they themselves convey to the nipple. 
Affected with a genital chancre, they cany their fingers to the 
diseased parts, they soil them, and then, without previous wash- 
ing, they draw upon the nipple, more or less irritated, and thus 
implant a chancre, which they do not fail to transmit to the 
child. The position of these mammary chancres, of which I 
have recently seen a very beautiful example in the wards of M. 
Cullerier at the Lourcine, is very well explained by the man- 
ner in which the women take the breast to give it to the infant. 
I have caused another very beautiful example to be designed in 
the clinique iconographique (19e Irvraison.) 

Here is another means of contagion in nurses. I have met 
with one in whom a chancre had been communicated to the 
breast by an individual affected with a primitive chancre upon 
the lip, and who thought that he should render a good service 
to this woman in drawing off the milk by suction. Very recent- 
ly there was a young man in my hospital having a primary ulcer 
upon the mamma, with numerous and indolent swellings of the 
axillary glands, which were followed at the end of six weeks 
with an enlargement of the posterior cervical glands, and with 
a confluent roseola. This young man had been contaminated 
by his mistress, who, with a chancre*upon the lips, had lavished 
upon him some eccentric kisses. 

Another mechanism. I have seen a nurse come to Paris to 
claim indemnity for a syphilis, which she said she had taken 
from the infant which she nursed. This woman had an indu- 
rated chancre upon the inner side of each mamma ; these chan- 
cres were placed opposite to each other. As to the child, rotten, 
according to the nurse, it was simply suffering under a porrigo 
larvalis of the most common description. The parents, who 
were perfectly healthy, little satisfied with the accusation, and 
especially with the demand, resisted the pretentions of the 
nurse, from whom I obtained a complete avowal. A man irho 
wasnot her husband, in the fear of begetting a child and alter- 
ing her milk, had given himself up to acts upon her, which the 
pen refuses to trace. 

An infant can contract chancre at the time of birth, if the 
mother is so affected at the period of parturition. This is 
without doubt rare, but it is not impossible. These chancres 

360 Ricord's Letters on Syphilis. [June, 

which are very often apt to be confounded with secondary acci- 
dents on account of their varied and unaccustomed seats, con- 
stitute, as we can easily conceive, focuses of infection for the 
nurses, and are afterwards offered as proofs of the possible con- 
tagion of secondary accidents. What again apparently comes 
to the aid of this manner of viewing things, is that in endeavor- 
ing to go back to the source from which the infant could have 
been contaminated, in the case where we arrive too late, we 
can find nothing upon the mother, the primary accidents which 
she had at the moment of the parturition having had time to 
become cicatrised without leaving any traces. Then if the 
legal father has in his recollection the remembrance of any 
blennorrhagia in his early youth, everything is laid to the 
charge of heritage. But what can we say, when we do not 
find anything and have no confessions? 

Infants at nurse can be infected by strangers, whom we do 
not suspect. They might afterwards infect their nurses, and 
before these latter could perceive the disease of their infant, and 
especially before they could recognize the nature of it, and ac- 
count for what they themselves experience, the secondary 
accidents so prompt to develope themselves in young infants 
could have already appeared, and masked the point of depart- 
ure in a manner to render it not easily recognized. I remem- 
ber a remarkable case in this respect, for which my learned 
brother and friend, M. Richet, Surgeon at the Hospital de 
Lourcine, consulted me a few years ago. It was concerning 
a little daughter of a lawyer of Paris, still entrusted to the care 
of her nurse, and who was affected with syphilitic ulcerations 
upon the ano genital regions. The parents being perfectly 
healthy, and the nurse absolutely in a healthy state, although she 
might have been suspected, the question arose from whence 
could come the contagion, when we learned that a clerk in the 
house, at that time diseased, had the habit of seating this child 
naked upon his hands, often soiled, and which he had not al- 
ways taken care to wash. Without this discovery, how would 
they have explained the disease of this little child, and who 
would they have accused if the nurse had presented any trace 
or suspicion of syphilis? 

In ali these cases, with habit and perseverance we can suc- 
ceed in discovering the source of the accidents. But it is not 
always so. The mother of the child is perfectly healthy; the 
husband of [he mother is irreproachable ; the nurse is free from 
all suspicion; and yet the child becomes diseased with syphilis. 
Here, where is the contagion ? Permit me to cite to you a 
fact which could serve as an answer to this delicate question. 

A young woman, accompanied witn her husband much older 

1853.] The Speculwn as a means of Diagnosis. 361 

came to consult me for her child which she had just taken from 
the nurse, and which was infected with a constitutional syphilis 
which she accused the nurse of having communica'ed to it. 
The child was almost entirely covered with a moist scaly syph- 
ilitic eruption; the region about the anus and the labia was 
the seat of ulcerated mucous tubercles. The child was six 
months old, and according to the nurse it was at the etui of six 
weeks that the first accidents showed themselves. However, 
the mother and the husband affirm to me that they never under- 
went any contagion, and by a most careful examination, in fact, 
I could discover nothing either past or present. The nurse, 
examined in her turn, appeared to me perfectly healthy. Her 
own child, which she nursed at the same time as the sick infant 
was in excellent health. I was much embarrassed in the re- 
search for the origin of the syphilis of this child, when I received 
the next day the visit of a young cavalry officer, who came to 
consult me for a syphilitic plantar and palmar eruption with 
which fie was affected. This officer interrogated me with a 
touching solicitude upon the disease of the child which had been 
presented to me the day before, and he made me a confidant in 
the part which concerned him in this question; but as he did 
not know the laws of transmission, he was surprised to have 
begot a diseased child, inasmuch, said he, as he thought himself 
cured, and that he had no symptoms of the disease when he had 
connection with the lady, who in fact had not been diseased. 

After all that I have told you, my friend, you see how much 
reserve, prudence, care and attention are necessary, before ac- 
cepting as a demonstrated fact the contagion of secondary 
accidents. Do you not think with me, that lor establishing def- 
initely this law in syphilography, other facts are necessary than 
those at present deposited in the annals of science? — [Boston 
Med. and Surg. Journal. 

The Speculum as a means of Diagnosis. 

[We extract the following remarks of Prof. Henry Miller 
of Louisville, from his able Report to the Kentucky State 
Medical Society. The subject is one of deep interest to the 
profession as well as to the community at large :] 

"In a paper, on the use of the speculum, read before the 
Royal Medical and Chirurgical Society, May 28, 1850 Dr. 
Robert Lee makes the assertion, that in the two great classes 
of organic diseases of the uterus — malignant and non-malig- 
nant— and in all the displacements of the uterus, he has derived 

362 The Speculum as a means of Diagnosis. [June, 

little or no aid from the speculum, in their diagnosis and treat- 
ment. The writer confesses his unfeigned surprise when this 
assertion, by an author of Dr. Lee's standing in the obstetric 
department of the profession, first arrested his attention, in 
perusing the report of his paper in the London Lancet. In the 
discussion which ensued, none of the distinguished gentlemen 
present appear to have noticed it or animadverted upon it in 
such terms as it deserves. Let us, then, inquire whether the 
speculum is indeed superfluous, first, in organic diseases, and 
secondly, in displacements of ihe uterus. It will be conceded, 
we presume, that inflammation is an organic disease, and that 
it is, moreover, the architect of numerous other diseases of the 
same class. Now, Dr. Lee virtually affirms that the speculum 
is not needed to discover the existence of inflammation of the 
cervix uteri, and upon this we join issue with him, being willing 
to stake the fortune of the speculum on its trial by a jury of 
our peers. 

" If the speculum be discarded, we cannot discover inflamma- 
tion in this, its favorite lurking-place, except by the symptoms 
that accompany it, or by the touch, in the usual mode of exam- 
ination. Will the symptoms reveal it? Their uncertainty 
and the dimness of the light they shed, are proverbial. There 
may be pain or a sense of heat in one of the iliac regions, to- 
gether with back-ache and neuralgia of the musculo-cutaneous 
nerves of one or both thighs. There may be frequent and 
painful micturition or tenesmic irritation of the rectum. The 
menstrual function may be deranged, and there may beleucor- 
rhoeal discharge. But any or all of these symptoms may be 
present, and yet inflammation may not exist, while there may 
be inflammation, and few or none of these symptoms be com- 
plained of. OF the truth of these remarks no practitioner can 
be ignorant, who is much conversant with the diseases of fe- 
males, and is familiar with the use of the speculum. The writer 
well remembers the case of a lady, the mother of two children, 
who miscarried in her third pregnancy, and suffered severely 
with her head for more than a year afterwards. She com- 
plained of fullness of the head, with more or less pain continu- 
al! v, and occasionally with very acute pain. On the part of 
the uterine system there was no evidence of any thing amiss, 
except that she did not conceive again, and menstruation, 
though regular, was scanty, seldom lasting more than a day, 
and amounting to a mere show. There was not, at any time, 
leucorrhceal discharge, nor did she complain of pelvic pains, 
and yet when examined with the speculum, chronic inflamma- 
tion, with hypertrophy of the uterine neck, was discovered. 
This was cured by the usual treatment : menstruation returned 

1853.] The Speculum as a means of Diagnosis. 363 

to its healthy type, and the cephalic symptoms gradually aba- 

"Can the touch detect inflammation of the cervix? This 
question might be answered by another : could a blind surgeon 
detect cutaneous inflammation by the touch? The trnth is 
(and every accoucheur well knows it) noneof our senses is more 
deceptive than the touch, or more frequently leads to mistakes. 
The only discovery which can be made by it, in the matter 
under consideration, might be made as well by any other in- 
strument as by the finger, viz, the existence of morbid sensi- 
bility in the cervix uteri. When the inflamed cervix is pressed 
upon the finger, the patient usually winces, and so she would 
were it pressed upon by a stick. Morbid sensibility may, 
however, exist independently of inflammation, and cannot, 
therefore, be regarded as furnishing conclusive evidence in such 
an investigation. 

"Upon the whole, then, the practitioner who relies on the 
symptoms and touch only, for his diagnosis in these cases, can 
never know of a surety that inflammation exists : he may sur- 
mise it, but cannot possibly have any greater certitude than 
could a blind oculist concerning the existence and nature of 
inflammation of the eyes. 

" Ulceration belongs also to the class of diseases, in which, 
according to Dr. Lee's assertion, little or no aid is to he dei ived 
from the speculum, — howbeit he is incredulous as to the occur- 
rence of this morbid state, in the female sexual organs, except 
to a very limited extent. He says explicitly that he has never 
seen ulceration of the os and cervix uteri, which was not of a 
specific character, especially scrofulous and cancerous. To 
fortify himself in this position, seems to have been the main 
object of his paper; for could it be proved that ulceration is a 
rare disease in these parts, the speculum might the more readi- 
ly be driven from the field. Dr. Lee's clique, who rallied 
around him in the debate, felt equally with himself the neces- 
sity of expunging ulceration from the list of female sexual 
maladies. To accomplish this, they were forced to maintain 
that ulceration necessarily involves a palpable loss of substance. 
It is readily admitted that, in this sense, ulceration is a rare 
form of disease of the os uteri ; we are not sure, indeed, that 
we have ever once met with it, nor have we a right to look for 
deeply excavated ulcers in such a situation. The mucous mem- 
brane alone is commonly implicated, and this is here of such 
exceeding tenuity that it cannot be dissected from the subjacent 
tissue. The nearest approximation to a dissection, which can 
be made by the most skillful anatomist, is to lift it up, in delicate 
patches, upon the point of a sharp lancet. Supposing the mem- 

364 The Speculum as a means of Diagnosis. [June, 

brane to be destroyed, in its whole thickness, by the ulcerative 
process, there would not, therefore, be palpable loss of sub- 
stance or any thing like an ordinary ulcer upon the skin, or 
even upon the mucous membrane of the intestines. But there 
is, nevertheless, what fulfills the definition of ulceration, namely, 
a solution of continuity, in a soft part, accompanied by a puru- 
lent discharge, for it may be brought to light by the speculum, 
and when wiped with a sponge, a raw and often a bleeding sur- 
face is exposed. What matters it, if Dr. Lee and his partisans 
choose to call it ' abrasion,' ' excoriation,' or by any other name. 
Such a surface, produced by morbid action, were only the 
epithelium destroyed, is ulceration ; for there is solution of con- 
tinuity and there is purulent secretion. 

" Ulceration of the os uteri is usually accompanied by inflam- 
mation, and the symptoms to which it gives rise are nearly 
the same, only there is more constantly purulent leucorrhea. 
But this discharge does not always attend it; for the secretion 
may be so slight as to be absorbed, and there may be purulent 
discharge without ulceration. Ulceration cannot, therefore, be 
predicated of any case from the symptoms only. It may be 
discovered by the touch, when the roughness of the affected 
surface is well marked, but in the very great majority of instan- 
ces, nothing can be positively affirmed until the parts are 
brought under ocular inspection. Of this, every day's experi- 
ence convinces the writer more and more firml>. While 
inditing this report, he had occasion to examine a lady, 
from a distance, whom one of the most distinguished surgeons 
in this country, after examination by the touch alone, pro- 
nounced to be laboring under displacement of the womb, the 
organ being, as he assuied her, perfectly free from disease: the 
writer was soon satisfied, by a specular, as well as tactual ex- 
amination, that there was chronic ulceration of the os uteri, 
but no displacement of any kind ! 

"The committee will next attempt to estimate the claims of 
the speculum, as a means of diagnosis, in displacement of the 
uterus, the oiher class of cases, in which Dr. Lee says it is of 
no value. None of these displacements is clearly indicated by 
the symptoms alone, except retroversio uteri occurring in the 
pregnant state, in which the sudden and total suppression of 
urine, together with the severe sufferings of the patient, points 
plainly enough to its existence. But in the non-gravid state, 
neither retroversion, nor anteversion, nor prolapsus, (the most 
common of all the displacements.) is accompanied by such 
symptoms as throw any satisfactory light on the subject. To 
the touch, at least, an appeal must be made, and through it we 
may learn that the organ is displaced, and the manner of its 

1853.] The Speculum as a means of Diagnosis. 305 

displacement; but we cannot learn its pathological condition, a 
capital hiatus in the information we are in quest of; lor the 
speculum has taught us the frequent, nay, the almost constant 
co-existence of inflammation or ulceration of the cervix uteri. 
So true is this, that the writer can conscientiously declare that, 
since he has used the speculum freely in his practice, he has 
seldom seen an instance of prolapsus or retroversio uteri, un- 
complicated with inflammation or ulceration of the cervix ; and 
he is becoming more and more skeptical as to the existence of 
simple displacement of the uterus. His own view of the pa- 
thology of such cases, is that inflammation is the primary and 
essential disease, while the displacement is merely a sequence. 
Such is the doctrine advocated by Dr. James Henry Bennet, 
in his valuable practical work on 'Inflammation of the Uterus,' 
who attempts to explain the occurrence of prolapsus on the 
principle of the increased gravity of the uterus, acquired by 
inflammation. Dr. Meigs rejects the .doctrine, and thinks he 
has most triumphantly refuted it by showing, as we think he 
has very conclusively, the insufficiency of the explanation. — 
(Females and their Diseases, p. 137.) 

"But it does not seem to have occurred to Dr. Meigs that 
the doctrine may be true, while the explanation may be false. 
Grant the existence of inflammation of the cervix as the ante- 
cedent, and it may be that the irritation, established in the part 
and propagated to the neck of the bladder and to the rectum, 
will eventually cause prolapsus by the bearing down efforts 
which it provokes, and this, we suspect, is the true etiology. 

"Be this as it may, and whether inflammation is the antece- 
dent or the consequent of the prolapsus, the writer reaffirms, 
without the fear of successful contradiction, that inflammation 
or ulceration exists in nearly every case of displacement of the 
womb, and that it can be detected only by the speculum. 

"But Dr. Lee, as we have seen, not only renounces the 
speculum in the diagnosis, but also in the treatment of ihe whole 
class of diseases we have been considering. It is difficult to 
imagine the grounds of this renunciation. Can it be that the 
treatment of these diseases, by other means, has been so suc- 
cessful in his hands as to preclude the hope of improvement? 
If so, we sincerely congratulate him on his good fortune, in a 
field where all other practitioners, from time immemorial, have 
met with little else than discomfiture. For our own part, we 
are not ashamed to confess that, until we called the speculum 
to our aid, we were defeated on every hand, or, at best, victory 
so seldom perched upon our standard, that we were bound to 
regard our success as fortuitous, rather than merited. We 
never cured a case of prolapsus by the pessary, or of long- 

366 The Speculum as a means of Diagnosis. [June, 

standing leucorrhcea, connected with inflammatory or ulcera- 
tive disease of the cervix, by constitutional treatment and the 
ordinary local appliances. 

" Such filibustering may succeed in recent and trivial cases, 
but when the disease is more strongly intrenched, it can only 
be dislodged by a superior force operating directly and sys- 
tematically upon it. 

" These uterine affections are essentially local in their nature : 
they owe their origin to local causes, and are most successfully 
treated by local remedies. But the remedies must be suffi- 
ciently potent to make an impression upon the disease. The 
sprinkling of an inflamed or ulcerated os uteri, with simple or 
medicated water, by means of a syringe (the only local reme- 
dies resorted to by the filibusters) cannot be more efficacious 
than such piddling ablutions upon other parts of the body. 
What would be thought of a surgeon who should attempt to 
cure an external chronic inflammation by squirting a little wa- 
ter or solution of lead or zinc upon it, two or three times a day ? 

"The more potent remedies which are addressed to the af- 
fected part through the speculum are, chiefly the local abstrac- 
tion of blood by scarrification or leeching, and superficial or 
deep cauterization, according to the circumstances of the case. 
It is not the design of the writer to enter into details on this 
part of the subject; he begs to refer the Society to practical 
works, particularly to Dr. Bennet's treatise, already alluded to. 
He will, nevertheless, submit a few annotations, suggested by 
his own experience in this branch of practice, which has been 
pretty extensive. 

"First Local depletion may be effected as well by scarifi- 
cation as by leeching, when the inflammatory congestion occu- 
pies the superfices of the os uteri, and ought to be preferred, 
because it may be done more expeditiously, and is far less re- 
volting to the patient. When the inflammation is deep-seated, 
and there is little or no discoloration upon the surface, leeches 
should be employed, and half a dozen are commonly sufficient 
to procure as free bleeding as is desirable. Local bloodletting 
is a valuable part of the treatment of these cases, and ought 
always to be premised, whenever there is any considerable de- 
gree of inflammation. It is a good preparation for cauterization, 
and may be advantageously repeated, in conjunction with cau- 
terization, until the inflammatory congestion is subdued. 

"Secondly. With the same view, cold mucilaginous injec- 
tions — infusion of flaxseed or slippery elm — should be thrown 
into the vagina, by the patient, three times a day. But these 
will accomplish nothing unless a good syringe is provided, and 
the patient properly instructed in its use. The injections should 

1853.] The Speculum as a means of Diagnosis. 367 

be taken in a recumbent posture ; the syringe ought to hold 
several ounces and have a pipe, with a bulbous end, long enough 
to reach the superior portion of the vagina. 

" Thirdly. When the inflammation or ulceration is confined 
to the mucous membrane, with only slight enlargement, and 
no induration of the cervix, cauterization with the nitrate of 
silver in substance, is the only application which will be found 
necessary in most cases. This ought not to be repeated too 
frequently — an error, which the writer has reason to believe, 
is committed by some — not oftener than once a week. Six or 
eight of these hebdominal cauterizations may suffice to cure 
the disease; but in some c;ises, a longer perseverance may be 
necessary, and in a few. the inflammation may prove altogether 
refractory. In such instances, the writer's practice is to cau- 
terize once superficially with the potassa cum calce, and after- 
ward, with nitrate of silver as at first. 

"Fourthly. Should the inflammation have extended to the 
proper tissue of the cervix, and resulted in induration, deep 
cauterization with the potassa cum calce will be indispensable 
to restore the part to its normal state, and heal any ulceration 
which may exist. It is quite useless to treat such a condition 
with the nitrate of silver ; the ulceration will seldom be cured 
by it, and it can make no impression upon the deeper-seated 
disease. The writer has practiced deep cauterization, in many 
cases ; in several, he has used the actual cautery, and he has 
never known any serious accidents to follow. He is always 
careful, however, to apply the caustic through a tubular spec- 
ulum, and to sponge off the part, so as to guard against any of 
the caustic remaining and spreading to the sound parts, alter 
the withdrawal of the speculum. With this precaution, he 
considers it to be as safe to apply caustic to the cervix uteri as 
to the skin. Much obloquy has been cast upon the speculum 
on account of alledged abuses of cauterization, and the writer 
doubts not that there is some foundation for it; for he can 
easily conceive that the careless or inexpert use of such a po- 
tent agent, may produce extensive inflammation and sloughing, 
followed by unnatural adhesions and contraction of the genital 
passage. But such consequences are attributable to the awk- 
wardness or ignorance of the operator, and are no more 
chargeable to the speculum than is the transfixion of the vein 
in phlebotomy to the lancet. The writer can truly say that 
no such consequences have ever happened to him or need hap- 
pen to any one, fit to be trusted with the speculum. 

" Fifthly. Rest in a recumbent posture, more or less strict- 
ly guarded, according to the degree of inflammatory action 
that exists, is a material adjuvant in the treatment of these 

368 The Speculum as a means of Diagnosis. [June, 

cases : and where this cannot be enforced, the disease is greatly 
prelonged, and may prove altogether ungovernable. 

" Exercise, or even the erect or semi-erect position tends in 
a direct manner, to increase the uterine congestion and aggra- 
vate the sufferings of the patient. The writer cannot doubt, 
from what he has seen, that much mischief is often done by 
urging the patient to take exercise, under the fallacious idea 
that weakness is the sum total of her ailments, and that if she 
can only be strengthened by air and erercise, all will be well 
with her. 

" So strongly is the imagination of some physicians haunted 
with the bugbear, weakness, that they will persist in keeping the 
patient in motion, notwithstanding that every step is a dagger 
to her. When shall more rational views obtain currency in the 
profession? How long shall a mere effect engross the atten- 
tion, while the cause is overlooked ? 

"The writer was recently consulted in the case of a lady, 
who suffered greatly from pelvic pains after her second con- 
finement, increased by exercise or the erect position. She had 
hemorrhagic discharges from the uterus for several weeks 
after parturition, with almost daily febrile excitement, intense 
thirst, loss of appetite, and general debility. The debility 
unfortunately, absorbed the attention of her medical attendant, 
and to remedy this, exercise in a carriage was commenced on 
the eleventh day after her accouchment, and persisted in daily 
in spite of her remonstrances, extorted by the increase of her 
suffering, and finally, she was sent away on an excursion in 
pursuit of the ignis fatuus, ' strength.' When she returned 
home, a specular examination was made, and a high degree of 
inflammatory engorgement of the uterine neck and upper por- 
tion of the vagina, with ulceration around the os, was discover- 
ed, which had existed doubtless since her delivery. 

" Sixthly. Although the local treatment is paramount to 
every thing else the state of the general system must not be 
overlooked or neglected. If constitutional irritation exist, it 
must be subdued by appropriate remedies, or if any of the func- 
tions are sympathetically deranged, ihey must be restored to 
a healthy condition by suitable treatment. In recent cases, 
some degree of febrile excitement not unfrequently exists, and 
to allay this, it may be proper to put the patient upon an abste- 
mious regimen, to purge actively every day or every other day, 
and if there be hardness as well as acceleration of the pulse, 
genera] bloodletting mav be necessary. 

'Dr. Dewees was well aware, though he had not the ocular 
proof, of the existence of uterine and vaginal inflammation, in 
many instances of leucorrhea, which is only another name for 

1853.] Intestinal Fistulce. 369 

the disease we have been considering, and the success of his 
treatment was doubtless attributable to the bleeding and purg- 
ing he prescribed, rather than to cantharides, which he regarded 
as a kind of specific. This is fairly to be inferred, from the 
fact that none of his cotemporaries or successors have been as 
fortunate in the use of cantharides as himself, which can be ac- 
counted for only by supposing that they have relied principally 
upon the specific, to which the multitude are always prone, to 
the neglect of due attention to the state of the system. It is not 
intended to be asserted that cantharides is devoid of all reme- 
dial virtues in these cases. By its action upon a contiguous 
and associated viscus, it may exert some beneficial influence 
upon the genital organs; nevertheless we are persuaded that 
the antiphlogistics, so vigorously employed by Dr. Dewees, 
had a larger share in extinguishing the disease than had the 
cantharides pushed ever so often usque ad stranguriam. 

" Jn more protracted cases, the general state is characterized 
by veritable debility, a languid circulation, coldness of the ex- 
tremities, and impaired digestion and assimilation. Under such 
circumstances, it will be proper to administer tonics, especially 
seme of the preparations of iron, and to regulate the secretions 
and excretions by the use of alteratives and purgatives. The 
selection of these will be governed by the indications of each 
particular case. As to purgatives, it is necessary to observe 
that only such of them are admissible as may be required to 
procure one full alvine evacuation daily, to effect which a pill 
or two of rhubarb and extract of colocynth, or of rhubarb, aloes 
and soap, may be taken every night. 

"Mercury, iodine, arsenic and antimony, are among the 
most powerful alteratives, and the indications for the use of 
remedies of this class may be fulfilled by the various prepara- 
tions and combinations of these agents. 

"As to sarsaparilla, which is so often prescribed, we do not 
know that we have ever obtained any good from it, even 
when furnished by the regular apothecary ; while sure we are, 
that the quack ish preparations of it, which find their way by 
the hogshead into the stomachs of our nostrum-loving popula- 
tion, are utterly worthless/' 

Report of Two Cases of Intestinal Fistulce. By De Laskie 
Miller, M. D., Chicago, III. 

CaseI. Visited Johnson, aged about 12 years, January 

22nd, 1850, found him with considerable febrile movement, 
with severe pain in the right iliac region, increased on pressure, 
and continuous, bowels constipated. Directed fomentations to 

370 Intestinal Fistulce. [June, 

the painful part, and ordered a Cathnrtic, to be followed by a 
full dose of Dover Powder. 22rd — The Cathartic operated 
kindly, removing a large quantity of hardened fasces. His 
pulse is 120 in the minute — tongue dry — pain in the right iliac 
region, about the same as yesterday. Some tumefaction cor- 
responding to the seat of pain. — Continue fomentations, and 
prescribed the following: — ty Hyd. Prot. Chlor. grs. viij. Pulv. 
Doveri 9j. — M. Div. Chart No. 4. take one every fourth hour. 
24th. — Patient much the same as yesterday — pulse rather 
softer and 110 — tumefaction increasing, but circumscribed. 
Ordered a laxative, to be followed by Dover Powder, sufficient 
to quiet the pain. Applied a blister to the whole extent of the 
painful part. 

The blister drew well, and discharged freely, the tongue be- 
came moist — the pain gradually subsided, though tenderness to 
pressure remained — the swelling increases, without extending 
its boundary, which is about five inches in diameter. After 
several days, detect fluctuation in the part, there seems to be 
great exhaustion of the vital forces, the patient complains of 
debility, and a sense of depression. He states that two days 
before I visited him, he received an injury at the point affected 
by falling upon a billet of wood. 

Punctured the swelling, which discharged a large quantity 
of foetid gas, and a small quantity ofgrumous blood, mixed with 
unhealthy pus — the tumefaction immediately subsided, and a 
distinct ring marking the boundary of the swelling remained. 
Ordered a cataplasm to be applied to the part, and prescribed : 
— Sulph. Morphia, as occasion required to keep the patient 
quiet. February 10th. — Three days after the abscess was 
punctured, the discharge consisted almost entirely of faeces, 
with portions of partly digested food ; no natural evacuation 
from the bowels during the last three days. Ordered injections. 

The anema produced a slight evacuation from the bowels ; 
the patient feels but little pain. Advised a nourishing diet, 
and porter. March 15th. — The patient improving in strength 
— the Artificial opening assuming the appearance of a fistulous 
orifice, and discharges as last noted. The lower portion of the 
bowels have been kept open by the use of injections, alternated 
with croton oil. April 15th. — The patient so much improved, 
as to ride 25 miles, to the residence of his father. The discharge 
the same in quality as last noted, but less in quantity. The 
orifice is evidently smaller. January. — One year after the at- 
tack, the patient has perfectly recovered ; the orifice continued 
to contract, the discharge becoming less, and finally ceased 

Case 2. Niles had been sick two weeks, and under treat- 

1853.] Intestinal Fistulce. 371 

ment for inflammation of the bowels, when I was called to see 
him, in consultation, found him with pain in the right iliac 
region, which was increased on pressure, had taken Calomel 
largely, and been catharticised freely. A blister was applied 
over the seat of the pain, and anodynes prescribed. About two 
weeks subsequent to this time, 1 was requested to visit him 
again, and take charge of the case, he was at this time very 
much debilitated ; pain end tenderness in the iliac region same 
as before, but found an abscess pointing about two inches to 
the right side of the spinous process of the second lumbar ver- 
tebra: punctured it, when it discharged freely, pus intermin- 
gled with flakes of lymph, poultices were applied to the part, 
and tonics prescribed. On the second day after the abscess 
was opened, faeces were observed to escape from the orifice, 
and occasionally portions of undigested food. About three 
weeks subsequent to this, another opening was formed about 
two inches internal to the anterior superior spinous process of 
the ilium, giving exit to a similar discharge. The opening on 
the back now began to contract, and finally closed, about six 
weeks after it was formed. After the time the first opening was 
made, it was difficult to produce an evacuation per anum. In- 
jections were used, alternated with croton oil. 

This course was followed for near six months, and the patient 
sustained by tonics and a nourishing diet, when the fistulous 
opening gradually contracted, occasionally closing for a few 
days, then opening for a short time, and discharging as before, 
till at the end of eighteen months, when it remained closed, and 
the patient regained his usual strength and spirits. 

Re?narks. There seems but little doubt, that in the case of 
Johnson, the inflammatory action, and consequent ulceration 
were induced by the injury received by the fall, the billet of 
wood forcing the walls of the abdomen, and coats of the intes- 
tine, against the accumulation of hardened faeces, contained 
within the Colon at the time producing contusion, and possibly 
slight laceration of the coats of the intestine. We see exem- 
plified in this case the beautiful provision of natnre, which by- 
forming adhesions between the various structures, around the- 
injury, prevents the fatal consequences that would ensue, from 
the escape of foreign substances into the peritoneum. A point 
of practical importance is the propriety of the early openings,, 
from the great depression of the vital forces; the inference in 
this case was, that the contents of the abscess were producing 
serious mischief, which was, manifested upon the escape of the 
foetid gas, and the relief which followed. 

In the case of Niles. is it not probable that some solid foreign 
body had found its way, perhaps, into the appendix vermiformis 

372 Creasote in Deafness. [June, 

whence it could not dislodge itself, causing the inflammation and 
ulceration, and leading to the abscess? None such was discov- 
ered in the discharges, although the attention of the parents was 
directed to it. But it is easy to understand how it might escape 
unobserved in ihe great amount of matter that was constantly 
discharging. Not ihe least practical point in these cases is the 
use of croton oil, this article fulfilled the indicatives admirably, 
it produced a uniform peristaltic action throughout the entire 
extent of the intestinal canals, without irritating the internal 
oiifice of the fistula, by its bulk. In the management of the 
above cases, the reader will notice an apparent disregard of the 
opinions of the older physicians, " who, in injuries of the abdo- 
men, extending to the intestines, never left anything to nature." 
\_North- West Med. and Surg. Journal. 

On the employment of Creasote in Deafness. By Dr. Harri- 
son Curtis. 

One of the principal causes of deafness is the absence of the 
secretion of cerumen in consequence of a fault in the action of 
the ceruminons glands. Often in my clinics, even when the 
deafness has continued for a long time, I have observed that it 
has no other cause, and on removing t Fiat, I have caused the 
infirmity to disappear. It is very true that to obtain this re- 
sult, more or less time is necessary, according to the duration 
of the infirmity, and in proportion to the gravity of the first 
cause of the inaction of the glands. After having cleansed the 
auditory meatus, and re-opened, so to speak, the orifice of the 
passage, by removing ihe morbid secretion which obstructs it, 
the use of a moderate stimulant is indispensable to reestablish 
the normal action of the glands. But before all, it is necessary 
to cleanse the auditory meatus, as no remedy can have the least 
effect, unless this operation has been well performed. In gen- 
eral I employ a preparation composed of half an ounce of beef's 
gall and a drachm (un gros) of tincture of castor or tincture of 
musk. With it I moisten a piece of cotton, which I place in 
the auditory meatus at night, to soften the hardened cerumen. 
In the morning I syringe the ear with warm water, to which 
may be added an ounce of soap liniment and a little cologne. I 
have often substituted with advantage, for the preparation of 
beef's gall and tincture of castor, the solution of potass of our 
Pharmacopoeia London ?) with the oil of sweet almonds, to dis- 
solve the cerumen. 

I would recommend for this operation, to be particular in the 
choice of a syringe. When the ear is well cleansed, and the 
glands are in such a state that a stimulant can act upon them, 

1853.] Bloodletting in Apoplexy. 373 

I would advise, in accordance with results which I have obtain- 
ed from my clinical experience, the employment of a solution 
of creasote in oil of (sweet) almonds, to induce the ceruminous 
glands to resume their normal action. The following is the 
formula which I employ — 

$ Creasote - f. 3j. 

Oil of sweet almonds f. 3iv. fit. and with a badger's 
hair pencil put a small quantity in the auditory passages night 
and morning. I ordinarily commence with a solution of this 
strength, and augment the quantity of creasote according to 
the effects obtained. Cases, however, present themselves, in 
which no good result will be obtained from this application 
without applying behind the ear a vesicatory of ointment of 
tartarized anitmony, or other derivatives. In otorrhcea, and 
always when there is pain or inflammation the creasote is con- 

Its application causes no pain or unpleasant sensation, but 
only an agreeable feeling of warmth. — [Lancet. 

Is not Blood-letting sometimes dangerous in Apoplexy? By 
M. Aussaguel. 

This question assuredly merits the attention of every practi- 
tioner. M. Aussaguel has collected in his inaugural thesis, 
from which we borrow this extract, a number of facts upon 
the subject, which demand grave consideration. 

"M. Cruveilhier when he lectures upon the treatment of cer- 
ebral haemorrhage, never fails to say 'undoubtedly it is neces- 
sary to bleed, but be very circumspect,' * * * «nd then he 
relates candidly, that having been sent for to visit a patient in 
the city, whom he found threatened with an apoplectic attack, 
he hastened to open a vein ; the w T ound was scarcely closed 
when the patient was attacked with hemiplegia: and he adds, 
'the relatives of the patient did not hesitate to say that it was 
mv lancet that had done the mischief.' 

"Since then we have read the thesis of M. Cornil : 'A wo- 
man,' says he, ' whom I observed last year in M. Rostan's ward, 
was occupied with her household duties, when she experienced, 
all at once, a loss of power in her left upper and lower extrem- 
ity. She with difficulty walked to the house of her physician, 
who bled her immediately. After the venesection, she was 
unable to rise: she was completely hemiplegic' 

"The following instance came under our own observation. 
A friend came to us, stammering in such a manner, that he re- 

n. s. — VOL. IX. NO. vi. 24 

374 Bloodletting in Apoplexy. [June, 

quired fifteen minutes to make us understand that, the morning 
of the same day, upon awakening he was greatly surprised to 
find himself in this condition. There was slight loss of power 
in the right arm, and its sensibility was diminished. Dr. Bata- 
ilhe having been summoned, practised venesection. The next 
day the stammering had increased, and the patient was copi- 
ously bled a second time. Syncope ensued, and the patient 
revived in fifteen minutes in a state of complete hemiplegia. 
It is now two years since he was able to utter a word. 

"I ask. then, if facts of this kind were numerous, would they 
not have a kind of accusing eloquence against the employment 
of blood-letting? and when an impartial witness observes their 
development, is he not tempted to say, with the relation of M. 
Crnveilhier's patient, ' it is the lancet that has done the mischief/ 

The author afterwards attempts to account for these excep- 
tionable cases, and his explanations are not without a certain 

"What occurs after blood-letting in certain cases of pneu- 
monia? Does not the weak, small, pulse become full, strong, 
and well developed? Do we not observe an increase in the 
forces of economy, and is it not generally believed that at that 
moment another congestive movement toward the lung occurs? 
Therefore rt is to combat the results of blood letting by blood- 
letting itself, that M. Bouillaud advises repeated venesection; 
in other words, the loss of the same quantity of blood is of 
greater efficacy when it is abstracted by several operations 
than by one. 

"Should we wonder if this were true also for the brain? 
Why wonder that this organ, enclosed in its unyielding case, 
engorged with blood, resists the tendency to haemorrhage for 
a time, and then yields to it after venesection, the circulation 
becoming at that moment more active? In other words, are 
there not two distinct causes operating in the production of 
apoplexy; the circulating mass, and the power which propels 
it? and does it not seem impossible to diminish the one without 
increasing the other ? 

"To diminish the first, without increasing the second, such 
should be the aim of the practitioner. 

"It is with a view to attain this end that we propose that a 
vein should never be opened until the head of the patient is 
elevated, and cold applications are made to it, and the blood is 
invited to the lower extremities by sinapisms or pediluvia, and 
the patient has taken some soothing draught, with a few drops 
of digitalis.'' — [Rev. Med. Chir. de Malgaigne. Virginia Med, 
and Surg. Journal. 

1853.] Treatment of Goitre by Electro-puncture. 375 

Treatmeat of Goitre by Electro-puncture. 

M. Jobert, of the Hofel-Dieu, is in the habit of treating goitre 
by electro-puncture. The operation is very simple; each of 
the conductors being furnished with a long needle, is plunged 
into the tumour, and the apparatus then charged. The opera- 
tion is not very painful, and may be repeated every day. The 
tumour gradually loses its bulk and hardness. M. Jobert has 
been successful in many cases, and in some, where this means 
is not effective or speedy enough, he injects iodine, which, after 
causing some inflammation, has the effect of causing resolution 
in the tumour, and curing it effectually. — \Gaz. des Hop. Ibid. 

Case of Catalepsy, illustrating some new principles of Treat- 
ment in Convulsive and Spasmodic Diseases. By Dr. C. B. 


William B , set. 12, residing with his parents at Shep- 

herd's-bush Bayswater, was seized on the first of February last 
with a painless rigidity of his forearms and hands, which fasted 
from tea-time, when it first made its appearance, until bed-time. 
Similar symptoms also recurred daily for many days, some- 
times beginning early in the morning and lasting throughout 
the day, at other times merely showing themselves for a few 
minutes, while the patient was preparing for bed ; and so thev 
continued to do until the 28th, at which time they extended to 
the feet and legs, and in less degree to the upper arms, thighs 
and trunk, consciousness being completely suspended, which 
was not the case previously. These general symptoms, which 
were evidently those of catalepsy, alternated with the more 
partial symptoms, occurring several times in a single day, and 
recurring throughout the whole of the next week, at the expir- 
ation of which period the case was brought to me. 

During all these fits, partial or general, the rigid parts were 
cold, — so cold as to cause some of the bystanders to say they 
were dead. Cold, also, had evidently much to do in the matter 
as an efficient cause. In the earlier stages of the affection, 
playing out of doors (the weather at the time being very severe) 
invariably sent the patient info 1 he house crving, with his hands 
and forearms immovable ; and the exposure caused bv undress- 
ing in a cold bed-room at night gave rise to the same symptoms. 
On the morning in which he was brought to me. also, the cold 
had acted in the same manner, and it was not until he had been 
some time seated in the warm room that the stiffening relaxed. 
I had thus an opportunity of satisfying myself that the parts 
which had lost their pliability were in reality cold, and that the 

376 Catalepsy, [June, 

pulse in them was almost extinguished, and the sensibility all 
but departed. I had the opportunity of satisfying myself, also, 
that this depressed condition exiended more or less to the sys- 
tem generally, and that all the mental and bodily functions 
were as far as possible removed from anything akin to excite- 

The other facts in connection with this case all denoted the 
want of real power. He was any thing but precocious, — not 
walking for two years*, and not talking for a year later, and 
now speaking with hesitation, — very slow in apprehension, 
feeble in memory, and, though twelve years of age, as irrita- 
ble, uncertain, and fretful as an infant. His head is large; his 
eyes staring, and the pupils dilated and sluggish ; his complex- 
ion sallow and venous; his hand cold and clammy; his pulse 
slow (70) and feeble; his body prominent and hard; his skin 
unhealthy and covered wirh boils; his appetite voracious. 
Both parents appeared to he healthy ; but a cousin of the mo- 
ther suffered from fits of a similar character, and lost her life 
in one of them, by falling from a foot-bridge into a brook. 

Acting upon received views, that increased irritation in the 
chief nervous centres had to do with the muscular rigidity. 
Mr. Roy, of Brookgreen, had tried the usual course of leeches 
behind the ears, blisters to the nape of the neck, low diet, mer- 
curials, hot mustard fomentations to the feet, and so on ; but 
finding the symptoms becoming more general and confirmed, 
he sent the case to me. 

The treatment I pursued rested, on the contrary, on the sup- 
position that rigidity was dependent on a diminished supply of 
nervous and other motive stimulus, a view which I have else- 
where endeavored to substantiate in relation to all forms of 
muscular contraction, normal and abnormal. I, therefore, re- 
commended that the patient should be kept still, and as warm 
and comfortable as possible; that animal food and good table- 
beer should be given him freely; that he should be undressed 
before the fire, and carried to bed wrapped in warm flannels, 
having been first for some time immersed in a hot bath ; and 
that he should take, every few hours, a small teaspoonful of 
spirits of turpentine, with ten drops of aromatic spirits of am- 
monia, mixed up with a part of the yolk of an egg, in a little 
ginger wine. 

A fortnight after this first interview, I saw the patient again, 
and found that the draught had occasioned a little irritation in 
the bladder, but so little that there was no necessity to discon- 
tinue the remedy. On the other hand it had put a stop to a 
troublesome and old-established habit of micturating in bed. 
As to the rest, there was a material improvement in every re- 

J853.] Gutta Per cha in Diseases of the Skin. 377 

spect, the countenance being brighter and more energetic, and 
there having been no cataleptic rigidity from the day the stim- 
ulant and nutritive plan of treatment had been put in practice. 
I saw the patient no more ; but learned from the mother, 
who called two months subsequently, that the treatment had 
been carried out, for a month longer, that the fits had never 
returned, and that he was then in better health than he had 
been before. — \London Lancet. 

On the Application of Gutta Percha in the Treatment of Dis- 
eases of the Skin. By Robert J. Graves, M.D., F.R.S. 

Dr. Graves has been making many successful experiments 
with Gutta Percha dissolved in Chloroform, in a great variety 
of cutaneous affections. He finds its application more suited 
for dry, scalv, tubercular and chronic diseases of the skin than 
for acute affections, attended with much oozing of fluid and 
comparatively acute inflammation. 

Still, its good effects, he says, are by no means limited to 
chronic diseases of the skin, or to those of a scaly, dry nature; 
for, as will hereafter appear, I have seen it decidedly useful in 
the spreading form of impetigo. My experience of this remedy 
makes me anxious to witness its application in the first stages 
of erysipeles, as analogy leads me to hope for good results in 
such cases. 

In acme of the face, this application is of essential impor- 
tance. The pimples should be covered with the solution, and 
the patient enjoined not to rub ofYihe pellicle by washing, etc. 

Finally, in several cases of psoriasis I have applied this solu- 
tion with great benefit. 

When my friend, Dr. Stokes, heard of my success in other 
cases, he resolved to try the gutta percha solution in small-pox, 
and it gives me great pleasure to say, the result of two t rials 
is most encouraging, and leads us to hope that at length a 
means of preventing the formation of disfiguring scars on the 
face in that disease has been discovered. Dr. Stokes allows 
me to publish the two following cases : 

The first Ann Kenny, aged 18, was admitted into the Meath 
Hospital, May 11, 1852. She was never vaccinated ; her illness 
began on the 6th of May, with the usual symptoms. On the 8th 
the eruption appeared, and on coming into the hospital it was 
wen formed and co. lnent on her face; the fever of a typhoid 
character, with considerable prostration of strength ; she was 
much annoyed with pain and itching of her face. She was or- 
dered wine and carbonate of ammonia mixture, and her face 
to be painted with a solution of Gutta Percha in Chloroform. 

378 Miscellany. [June, 

The solution was applied with a soft brush, the entire face 
being well coated with it, and after an interval of five minutes 
(just sufficient time to allow the previous coating to dry,) a 
second coat of the solution was applied. 

This application gave her great relief, and allayed the pain 
and itching. On the 13th she was much better, and the solu- 
tion was again applied in the same manner. 

May 22d. The crusts came off in large pieces, and there was 
scarcely any trace of the disease remaining, except a slight 
discolouration. During the whole time of her illness, from the 
application of the solution her face continued moist, and there 
was no ulceration in any place. 

The second case presented similar symptoms ; was treated 
in the same manner, with the like happy result. 

It is of essential importance to observe that ihe gutta percha 
solution should not be applied to the face until the pustules are 
fully maturated, otherwise injurious consequences may arise. 

Lupus supiginosis, psoriasis and other chronic cutaneous 
complaints, when unattended with constitutional derangement, 
yield readily to repeated applications of the solution of gutta 
percha. — [Dublin Quarterly Jour, of Med. Science. 

SX\ Bttil an 2 • 

" The Aztecs." — We have, in common with our fellow citizens, re- 
cently had an opportunity to see the two little personages, whose arrival 
in this city was heralded in the public prints and announced by pla- 
cards upon our street corners as " The Aztecs, a new race of people, 
two feet high — a complete puzzle to all beholders." The story of 
their being the descendants of a dwarfish race of Aztec priests, held 
in great veneration in a mysterious and hitherto unknown city, hidden 
amidst the mountains of Central America, is too absurd to arrest the 
attention of Naturalists, yet remarkably well adapted to the purpose 
for which it was invented. Every one who knows anything about 
the history of Dwarfs is aware that they do not procreate — that they 
are impotent. Theso little creatures were at one time much sought 
after and petted by the courts of Europe, which seemed to vie with 
each other in the possession of the most remarkable specimens of abor- 
tive humanity. Attempts were then repeatedly made 'by authority" 
t increase the supply by coupling the parties ; but always in vain. 

If the " Aztecs " are not dwarfs, as alleged by their keeper and 
even by some Professional gentlemen, we would like to know what 
they are. Walker defines the word Dwarf, " A man below the com- 

1853.] Miscellany. 379 

mon size of men"; Webster: "a general name for an animal or 
plant which is much below the ordinary size of the species or kind. 
A man that never grows beyond two or three feet in height, is a 
dwarf." Dunglison : " one who is much below the usual stature." 
Now the male of these "Aztecs" is said to be 18 years of age, 
33f inches high, and to weigh 20 lbs. ; the female is said to be 
10 years of age, 29^- inches high, and 17 lbs. in weight. They 
were carefully examined by Dr. J. M. Warren and others in Boston, 
in the early part of 1851, who estimated, from inspection of their 
dentition, the age of the boy to be from 7 to 8 years, and that of the 
girl to be from 4 to 6 years. The boy was 33£ inches high and 
weighed 20f lbs. The girl was 2£|- inches high and weighed 17 lbs. 
It appears, therefore, that their stature and weight have undergone 
little or no change in two years. Their brain is exceedingly small 
and their mental faculties are correspondingly defective. It is true 
that they are lively and cheerful, but they have as yet no knowledge 
of language, beyond the ability to repeat after their "keeper" a few 
words, such as, papa — mamma — dec, without any apparent conscious- 
nesss of their meaning. When addressed, they seem to apprehend ra- 
ther the intonation of the voice, as do brutes, than the articulation of 
words. Yet we are told that they are neither dwarfs nor idiots. Let us 
again refer to our lexicographers : — Walker's definition of the word 
Idiot, is "a fool, a natural, a changeling," and "Idiocy, a want of 
understanding." Webster: "Idiot, a natural fool, or fool from his 
birth," and "Idiocy, a defect of understanding; properly a natural 
defect." Dunglison: "Idiot — foolish', stupid, ignorant. Now used 
for one who is fatuous, or who does not possess sufficient, mental facul- 
ties for the social condition, and for preserving, himself from danger. 
In law, one who has been without understanding from his birth, and 
whom the law presumes to be never likely to attain any." The 
" Aztecs " are then certainly not only dwarfs, but also idiots. 

In thus endeavoring to remove the mystery attempted to be thrown 
over the origin and true character of these beings, we do not mean to 
detract from their interest philosophically considered, for they present 
certain remarkable peculiarities. They appear to be of a mixed 
race ; probably an admixture of the Negro and American Indian, 
such as may be found in Mexico and most of the South American 
States. They differ strikingly from all the dwarfs we have seen, and 
from most of those upon record, in the smallness of their head ; for 
dwarfs usually have this proportionately more developed than the 
other parts of the body, whereas in these, the arrest of evolution has 

380 Miscellany. [June, 

operated equally upon the brain and the general system. Hence it is 
that whilst dwarfs usually speak correctly and are sometimes quite 
intelligent, the Aztecs are unable even to ask for the necessaries of 

Pulmonary Calcareous Concretions. — We are indebted to Dr Jas. 
M. Scaife, of Claiboin Parish, Louisiana, for several very handsome 
specimens of calcareous concretions expectorated by a patient affected 
with consumption. The Doctor states that quite a large number of 
them were coughed up with purulent matter. 

Such concretions, however, are not confined to phthisical subjects, 
but have been observed in the lungs of persons who have died without 
any serious lesion of these organs. They usually consist principally 
of phosphate of lime — and sometimes exist in very'great numbers in 
the pulmonary tissue. 

A new remedy for Warts. — A French writer states, in the " Bulle- 
tin de Therapeutique," that he has observed that the use of a tea- 
spoonful of Carbonate of {Magnesia, morning and ni-ht, for a few 
weeks, was generally attended with the disappearance of warts on 
the fingers. Whether this is to be regarded as an effect rather than 
a coincidence, seems to us questionable. Warts will often fall off 
after having existed a certain length of time ; hence the success of 
the incantations and other witcheries resorted to by certain "wart- 
curers." One of the most prompt applications w T e have tried is the 
Tincture of Iodine. By putting a drop of this upon the wart once a 
day, it will generally fall off in a week. Lunar caustic, nitric acid, 
potash, &c, will often- succeed very weil, but are apt, if incautiously 
applied, to occasion some inflammation and pain. 

A new treatment for Pertussis. — We find in the " Revue de Ther- 
apeutique," &c. that Prof. Hannon, of Brussels, rejects all the es- 
tablished methods of treating Hooping Cough, and recommends a 
nourishing diet of bread and meat, with a liberal allowance of wine 
at least three times a day. His directions are as follows : " In the 
morning, roasted meat and toasted bread with Port or Madeira ; at 
noon, bread and wine ; at 5 o'clock P. M., broth, roasted meat and 
toast; at night, no supper ; at bed time, wine : nothing but cold water 
between meals." He adds that, however singular this treatment may 
appear, the symptoms will begin to yield in a very few days and the 
cure be complete in from one to two weeks. This plan may be worthy 

1853.] Miscellany. 381 

of trial, but can of course be adapted only to children who have been 

Yellow Wax for making Ointments. — Dr. Henle (An. Medicale) 
having observed that unguents prepared with white or bleached wax 
became very soon rancid, urges the use of yellow wax — as by this 
means the unguents will keep fresh four times as long. 

"Warrenton, Ga., May 24th, 1853. 

" Dr. Dugas : — On the 5th inst., several of the Physicians of Warren 
County organized themselves into a Medical Society. A Constitution 
and By-Laws were adopted — the duty of drafting the same having 
been put upon some of the members of the Profession at a preceding 
preliminary meeting. 

" The meetings of the Warrren County Medical Society will be held 
bi-monthly, beginning on the 1st Wednesday in July next. The 
officers elected to serve ihe ensuing year, are : Jas. S. Jones, M. D., 
President; Robert W. Hubert, M. D., 1st Vice-President ; M. E. 
Swinney, M. D., 2d Vice-President ; VVm. H. Pilcher, M. D., Corres- 
ponding and Recording Secretary; Sterling Gibson, M D., Treasurer. 

(, I will merely state, for the information of those wishing to become 
members ef the Warren County Medical Society, that all applications 
for membership must be written, and presented to the Society through 
its Secretary. WM. H. PILCHER, 

" Corresponding and Recording Secretary/' 


Atlas of Pathological Histology. By Dr. Gottlieb Glfge, Profes- 
sor &c. in the University of Brussels, &c, &c. Translated from 
the German, by Joseph Leidy, M. D., &c, &c, of Philadelphia. 
With 320 figures, plain and colored. Philadelphia: Blanchard & 
Lea. 1853. 

Dr. Leidy certainly deserves the thanks of the profession for having 
placed within the reach of those who do not understand German, the 
very valuable woik of Prof. Gluge. As normal histology constitutes 
the fundamental study of physiology, so does morbid histology be* 
come indispensable in the acquisition of correct views of Pathology. 
In the present volume, this study is wonderfully facilitated by the 
numerous and beautifully executed engravings. The work is divided 
into sections, thus : 1st. Development of the elements of tissues; 
2d. The elements of tissues combined in perfect or imperfect tissues, 
and arranged according to the processes of disease ; 3d. Formation 




of the Blastema; 4th. The histological metamorphosis of the blood; 
5th. Pyaemia; 6th. of Gangrene; 7th. Observations on Histology. 
We take pleasure in recommending this work, not only as highly 
useful, but also as exceedingly creditable to the publishers. 

A Treatise on General Pathology. By Dr. J. Henl6, Professor of 
Anatomy and Physiology in Heidelberg. Translated from the 
German, by Henry C. Preston, A. M., M. D. Philadelphia : 
Lindsay & Blakiston. 1853. 

This work forms a valuable companion, or rather complement to 
that of Prof. Gluge, for the study of the topics upon which it treats 
should follow that of pathological histology. Prof. Henle is by com- 
mon consent ranked as one of the ablest pathologists of Europe. His 
work should therefore be perused attentively by practitioners who do 
not wish to remain ignorant of the advances made in this department. 

The Action of Medicines in the System ; or the mode in which Ther- 
apeutic agents introduced into the stomach produce their peculiar 
erlects on the animal economy. Being the Prize Essay to which 
the Medical Society of London awarded the Fothergillian Gold 
Medal for 1852. By Fk. Wm. Headland, B. A., M. R.C.S., &c. 
Philadelphia : Lindsay & Blakiston. 1853. 

The title alone of this work indicates the importance of its subject, 
and the award of the learned society vouches for the faithfulness of 
the execution. We have not yet had an opportunity to examine it 
carefully, but as far as we have looked into it, the impression has 
been very favorable. The general modes of action of therapeutic 
agents introduced into the stomach are treated of in ten propositions. 

Prop. I. That the great majority of medicines must obtain entry 
into the blood, or internal fluids of the body, before their action can 
be manifested. 

Prop II. That the great majority of medicines are capable of solu- 
tion in the gastric or intestinal secretions, and pass without material 
change, by a process of absorption, through the coats of the stomach, 
and intestines, to enter the capillaries of the Portal system of veins. 

Prop. III. That those medicines which are completely insoluble in 
water, and in the gastric and intestinal juices, cannot gain entrance 
into the circulation. 

Prop. IV. That some few remedial agents act locally on the mu- 
cous surface, either before absorption, or without being absorbed at 
all. That they are chiefly as follows: 

a. Irritant emetics, b. Stomach anaesthetics, c. Irritant cathartics. 

Prop. V. That the medicine, when in the blood, must permeate 
the mass of the circulation, so far as may be required to reach the 
parts on which it tends to act. 

That there are two possible exceptions to this rule : — 

1853.] Miscellany. 383 

a. The production of sensation or pain at a distant point, b. The 
production of muscular contraction at a distant point. 

Prop. VI. That while in the blood the medicine may undergo 
changes, which in some cases may, in others may not, afiect its influ- 
ence. That these changes may be — 

a. of Combination, b. of Reconstruction, c. of Decomposition. 

Prop. VII. That a first class of medicines, called Haematics, act 
while in the blood, which they influence. That their action is per- 
manent. 1. That of these some, called Restoratives, act by supply- 
ing, or causing to be supplied, a material wanting, and may remain 
in the blood. 2. That others, called Catalytics, act so as to counter- 
act a morbid material or process; and must pass out of the body. 

Prop. VIII. That a second class of medicines, called Neurotics, 
act by passing from the b'ood to the nerves or nerve-centres, which 
they influence. That they are transitory in aciion. 1. That of 
these some, called stimulants, act so as to exalt nervous force, in ge- 
neral or in particular. 2. That others called Narcotics, act so as first 
to exalt nervous force, and then to depress it ; and have also a spe- 
cial influence on the intellectual part of the brain. 3. That others 
again, called Sedatives, act so as to depress nervous force, in general 
or in particular. 

Prop. IX That a third class of medicines, called Astringent', act 
by passing from the blood to muscular fibre, which they excite to 

Prop. X. That a fourth class of Medicines, called Eliminatives, 
act by passing out the blood through the glands, which they excite to 
the performance of their functions. 

Silliman's Journal — The May number of this national work is 
exceedingly interesting. Among its original papers we note those of 
Geo. Mathiot, "On the Electrotyping operations of the United States 
coast survey" — of Ogden N. Rood, "On a method of exhibiting the 
Phenomena of Diffraction with the compound microscope" — of J. B. 
Upham, M. D., " On the Phenomena and Laws of Sound " — of Prof. 
Wm. A. Norton, " On Ericson's Hot-air or Caloric engine." 

Meeting of the American Medical Association, at New York. — The 
session was opened on the 3rd of May. Dr. VVelford, of Virginia, 
President, in the Chair. The Delegates in attendance numbered 
upwards of 500. The following officers were elected for the ensuing 
year: President— Dr. Jonathan Knight, of Connecticut. Vice-Presi- 
dents — Dr. Usher Parsons, of Rhode Island; Dr. Lewis Condit, of 
New Jersey; Dr. H. R. Frost, of South Carolina, and Dr. R. L. 
Howard, of Ohio. Secretaries — Drs. E. L. Beadle, of N. York, and 
E. L. Lemoine, of Missouri. Treasurer — Dr. D. F. Condie, of 

384 Miscellany. [June, 

Medical Society of the State of Georgia. 

Savannah, Ga., April 13th, 1853. 
The Medical Society of the State of Georgia met at 10 o'clock this 
morning in St. Andrew's Hall, and was organized by calling Dr. R. Q. 
Dickenson, of Baker county, to the Chair. The roll of members 
having been called, the rules were suspended, and eighteen gentle- 
tlemen admi'ted to membership in the Sociely. An election for 
officers was now held, and the following gentlemen duly elected offi- 
cers of the Society for the ensuing year : 

President — Dr. P. M. Kollock, Savannah, Chatham Co. 
1st V. President — Dr. R. Q. Dickenson, Albany, Baker Co. 
2d " " Dr. G. F. Cooper, Perry, Houston, Co. 

Cor. Secretary — Dr. Vy. N. King, Savannah, Chatham Co. 
Rec. " Dr. D. C. O'Keeffe, Greenesboro', Greene Co. 

Treasurer — Dr. C. B. Nottingham, Macon, Bibb Co. 

Delegates to American Medical Association. 

Dr. E. L. Strohecker, of Bibb Co. 

" J. C. Gilbert, " Houston, 

" H. F. Campbell, " Richmond, 

" R. C. Mackall, ■ " Chatham, 

" R. McGoldrick, " Bibb, 

" L. A. Dugas, <k Richmond, 

" Ch. VVest, " Houston, 

" T. B. Hoxey, " Muscogee, 

Dr. T. R. Lamar, of Bibb Co. 
" J. E. Dupree, " Twiggs, 
M S W. Burney, " Monroe, 
" M.G. Slaughter, " Cobb, 
" Th. Stewardson, " " 
" J. M. Simmons, " Spalding, 
" T. M. Darnell, " DeKalb, 
11 Jno. Le Conte, " Clark, 

Dr. Long, of Athens, stated that he had published, in the Southern 
Medical and Surgical Journal, for 1849, his claims to priority of dis. 
covery of the anaesthetic properties of Sulphuric Ether, and he now 
presented the subject to the Society to take such action thereon as 
may seem to it proper. Whereupon, on motion of Dr. Dickenson, a 
committee of three (Drs. Dickenson, Cooper and S. N. Harris) was 
appointed to confer with Dr. Long, and investigate his claims to the 
discovery in question. 

On motion of Dr Nottingham, a committee of one from each Con- 
gressional District represented at this meeting was appointed to pre- 
pare business for the action of the Society. Drs. Arnold, Hillsman, 
Gilbert, Long, O'Keefle and J. Harriss, were appointed that com- 

A proposition was read from Dr. J. S. Wilson, of Alabama, to 
publish a Medical Almanack, detailing the evils of quackery, and 
expounding some of the fundamental principles of medicine, to be 
edited by him, and published at the expense of the Society. 

1853.] Miscellany. 385 

On motion of Dr. Dickenson, the Correspending Secretary was 
instructed to inform Dr. Wilson that his proposal was duly considered, 
but respectfully declined. 

The Corresponding Secretary read a letter of resignation from Dr. 
H. A. Ramsay, which, on motion of Dr. Cooper, was laid on the table 
for the present. 

On motion of Dr. Nottingham, a standing committee of three was 
appointed, for the current year, to investigate the finances of the So- 
ciety, and report thereon during the present session. Drs. Charters, 
J. Harriss and McGoldrick, committee. 

On motion of Dr. Bulloch : 

Resolved, That the gentlemen connected with the Press of the city 
be invited to take seats within the Hall, during the sittings of this 

On a call from the Chair for written communications, the follow- 
ing Reports were read, and received : 

On the existing Laws of Georgia, relating to the Practice of 
Medicine, and the Sale of Drugs, with suggestions for additional 
legislation — by Dr. R. Q. Di< kenson. 

On the Topography and prevalent diseases of the First Congress- 
ional District — by Dr. P. M. Kollock. 

On the Topography and prevalent diseases of the Third Congress- 
ional District — by Dr. G. F. Cooper. 

On the remittent peculiarities assumed by Typhoid Fever in Geor- 
gia — by Dr. H. R. Casey. 

On the best plan of treating Fractures in Country Practice — by 
Dr. L. A.. Dugas. 

On the anti-periodic properties of Sulphate of Cinchona — by Dr. 
Thos. W. Bell. 

On the treatment of Strictures of the Urethra, by rapid and free 
dilatation, illustrated with cases — by Dr. P. F. Eve. 

Biographical Sketch of the late Dr. Waring — by Dr. C. W. West, 

Biographical Sketch of the late Dr. Baber — by Dr. C. B. Not- 

On motion of Dr. Mackall, it was 

Resolved, That all the Reports received, and now upon the table, 
be referred to a Committee on Printing, who shall have discretionary 
power to print, or omit to print, such portions of them as they shall 
deem expedient. 

Drs. Mackall, Arnold and Posey, were appointed under this reso- 
lution ; and on motion, the President, Dr. Kollock, was added to the 

386 Miscellany. [June, 

Dr. Dickenson read the report of the committee on Dr. Long's 
claims, which was highly favorable, and the following resolution, ap- 
pended thereto, unanimously adopted. 

Resolved, That it is the opinion of this Society that Dr. C. W. 
Long, now of Athens, Georgia, was the first person who used Sulph. 
Ether as an anaesthetic agent in surgical operations ; and as an act of 
justice to Dr. Long, individually, and to the honor of the Profession of 
our State, we recommend him to present his claims to priority in the 
use of this most important agent to the consideration of the American 
Medical Association at its next meeting. 

Dr. S. X. Harris offered the following resolution which was adopt- 
ed : 

Resolved, That a Committee of five be appointed from this Society, 
to address the next Legislature of Georgia, and urge upon their con- 
sideration the propriety of enacting a law which shall exempt its 
members from Jury duty, and, except in time of actual war, from 
military duty, so long as they shall continue in this Society. 

Dr. C. W. West moved that all the members of the Society sign 
this petition. Carried. 

Committee appointed under the above resolution — viz : Drs. S. N. 
Harris of Chatham Co., I. E. Dupree of Twiggs Co., L. A. Dugas 
of Richmond Co., H. V. M. Miller of Floyd Co., Thomas Hoxey of 
Muscogee Co. 

Dr. Arnold called up Dr. Ramsay's letter of resignation, and offered 
the following preamble and resolutions, which were adopted, nem. dis. 

Whereas, a communication has been received from Dr. H. A. 
Ramsay, tendering his resignation as a member — and, whereas, Dr. 
Ramsay was admitted into this Society, as will appear from the 
minutes of the meeting of 1852, on the express ground that he had 
retracted his charges against the Society theretofore published by 
him ; and, whereas, since his admission, he has renewed his charges 
of a persecution, which exists only in his own brain, and has accom- 
panied those charges with scurilous abuse of several members of the 
Society — thus violating at once, professional and social courtesy, 
which charges he has printed and circulated in various forms : 

Resolved, That this Society cannot accept the resignation of Dr. 
Ramsay, and thus indirectly endorse the propriety ot his conduct while 
a member of the Society. 

Resolved, That agreeable to the amendment of the Constitution, 
adopted at the meeting of 1851, Dr. Ramsay be notified, in writing, 
that at the next regular meeting he will be arraigned before the So- 
ciety, as having grossly violated the code of Medical Ethics adopted 
by it for the government of its members, by various publications made 

1853.] Miscellany. 387 

by him during the past year, derogatory to the views and purposes of 
the Society, and the character of »ome of its members. 

On motion of Dr. Arnold, a committee of three was appointed to 
notify Dr. Ramsay of the passage of these resolutions. 

Dr. Arnold moved to amend the Constitution, by striking out from 
the 8th Article the words, "of not more than two dollars each." 

On motion of Dr. Howard, Dr. S. N. Harris, of Savannah, was 
appointed Speaker for the next annual meeting of the Society, and the 
city of Macon selected as the place of meeting. 

On motion of Dr. O'Keeffe, Dr. G. F. Cooper, of Perry, was ap- 
pointed Dr. Harris' alternate. 

The President announced the following Committee of Arrange- 
ments : — Drs. E. L. Strohecker, H. K. Green, T. R. Lamar, G. 
Harrison and R. B. Xesbit. 

On motion of Dr. O'Keeffe, it was 

Resolved, That the thanks of this Society are hereby tendered to 
the Georgia Medical Society, for their attention and courtesy to its 
members during their stay in the city. 

On motion of Dr. Nottingham: 

Resolved, That, to the professional gentlemen of Savannah, the 
members from the interior cannot fail to cherish feelings of the most 
kindly regard, in consideration of the cordial reception, affluent hos- 
pitality, and high toned spirit of fellowship, wilh which our arrival has 
been greeted, and our sojourn rendered pleasant. 

Dr. Arnold offered the following resolutions, which were adopted ; 

Resolved, That an assessment of 83 00, be made upon each mem- 
ber of this Society to defray the current expenses. 

Resolved, That the Treasurer notify all absent members of the 
above assessment, and request those delinquent for any past assess- 
ment to remit their clues to him. 

Resolved, That the present Treasurer notify Dr. Alexander, of 
Atlanta, and Dr Black, of Augusta, (former Treasurers of this Socie- 
ty,) of their delinquency, and request them to forward to him a full 
statement of the receipts and expenditures of all monies received by 
them, and the balance of funds, if any, in their hands.* 

The Chairman of the Committee on business, Dr. Arnold, present- 
ed the following Report, which was adopted : 

Subjects to be reported on at the next annual meeting. 

* It is but justice to Dr. Black, to state that he sent his annual Report by mail 
to Savannah, to the address of the Recording Secretary, during ihe recent meet- 
ing of the Society, but did not reach its destination in time to ohviate the pas- 
sage ot this resolution id relation to himseif; and from the known financial 
accuracy of Dr. B. we entertain not the least doubt ot its being correct and sat- 
isfactory.— (Rec. Scc'y.) 

388 Miscellany. [June, 

Medical Botany of Georgia. Dr. Joseph Le Conte. 

On the relative value of Lithotrity and Lithotomy. Dr. L. A. Dugas. 

On the use of Anaesthetic Agents in Obstetrical Practice. Dr. Jos. 

On the mutual relations of Yellow and Bilious Fever. Dr. P. M. 

On the Therapeutical value of the Bark of the Cornus Florida (Dog- 
wood), as a substitute for Quinine. Dr. C. B. Nottingham. 
On the Ve rat rum Viride, as a medicinal agent. Dr. G. F. Cooper. 

And that each person, thus appointed, be authorized to chose his 
alternate, in case he is not able to perform the duty. 

At 8 o'clock of Thursday night, Dr. Juriah Harriss, of Augusta, 
delivered, to a highly respectable audience, a chaste, instructive, and 
scientific address, on the History of Medicine in the 18th and 19th 

On motion of Dr. Arnold: 

Resolved, That the thanks of the Society be tendered Dr. Harriss, 
for his interesting address before them, and that a copy be solicited 
for publication. 

Hereupon, the Society adjourned, sine die. 

D. C. O'KEEFFE, Rec. Sec. 

Vermont Medical School. — A cotemporavy states that a third Medi- 
cal School is about to be organized in Vermont — and adds, that " if 
the three will unite, they may make one very respectable school. 
Rather a hard hit at our Eastern brethren. 

Prof. M. Clymer has resigned the Chair of Practice in the Univer- 
sity of New York — and Dr. John A. Swett has been appointed in his 

Dr. Joseph Leidy has been appointed to the Chair vacated by the 
death of Prof. Horner. A very good selection. 

Dublin has lost- one of her ablest physicians by the death of Prof. 
Robert J. Graves. 

Dr. Valentine Mott and Dr. John C Warren have been elected 
foreign members of the French Academy of Medicine. Why was Dr. 
Mott not elected to the Presidency of the American Medical Associa- 
tion ? He was certainly entitled to the honor. 



Vol. 9.] NEW SERIES.— JULY, {80, [No. 7. 

©riginal (ffammttnuattons. 


A brief Summary of my Experience with the Veratrum 
Viride. By John $. Wilson, M. D., of Airmount, Clarke 
county, Alabama. 

So much has recently been written upon the veratrum by 
Dr. Norwood, and others, that some may begin to grow weary 
of the subject ; but I feel well assured that such is not the case 
with those who have witnessed its wonderful powers, and that 
every physician who has enjoyed this privilege will read with 
pleasure any additional evidence in its favor, which may tend 
to bring it more into notice, and thus extend its use. And if 
any of the readers of this Journal should entertain the idea that 
an undue proportion of its pages are devoted to this new reme- 
dy, they should remember that almost a/Ztbat has been written, 
up to this time, upon this g're'at .medicine, has been published 
in this Journal alone ; that but few American and no European 
journals have as yet^ noticed it; and, consequently, that its 
transcendent claims to the attention of the profession are still 
comparatively unknown. Instead, then, of offering an apology 
for introducing the American hellebore again, I would pay a 
merited compliment to Dr. Norwood, by saying that he has 
won immortal honor for himself, and conferred an inestimable 
favor on mankind, in bringing it first into notice ; and I hesitate 

n. s. — VOL. IX. NO, vii. 25 

390 Wilson, on Veratrum Viride. [July, 

not to say that the Journal would be well filled if every page 
contained nothing besides an important account of the effects 
of veratrum viride. 

It is not my design to give a minute and tedious detail of 
cases ; I will only mention some of the diseases in which I have 
used the medicine under consideration — ttie mode of adminis- 
tration, and the result, together with such general remarks as 
may be suggested tome in common with each case. 

At the beginning of the present year, I succeeded in obtain- 
ing some of the root of the veratrum viride, after several 
ineffectual efforts : from this I made a tincture, according to the 
directions of Dr. Norwood, by adding | lb. of the root to li> oz. 
of undiluted alcohol. This tincture I have used in the follow- 
ing diseases — viz : Pneumonia, pleuropneumonia, bronchitis, 
broncho-pneumonia, pericarditis, cerebro-spinal meningitis, 
epileptiform convulsions, acute rheumatism, general dropsy ; 
and in fevers — typhoid, remittent and puerperal. Of the tho- 
racic diseases, sixteen were pulmonary and one cardiac: of 
meningitis, convulsions, acute rheumatism, and dropsy, there 
was one case each : of the fevers, three were typhoid, one 
puerperal, and several remittent. Of the sixteen pulmonary 
cases, all recovered save one, and this was complicated by the 
supervention of acute rheumatism. The case of pericarditis 
had resulted in effusion, before it was put under treatment, and 
terminated fatally : still the veratrum exerted its w'onted con- 
trol over the pulse, reducing its frequency from 140 to 60. The 
case of cerebro-spinal meningitis was also fatal; but as in the 
other case, the remedy exerted a marked control over the 
pulse, and for a while there was a flattering amelioration of all 
the symptoms. 

The subject of the convulsions was an anemic boy of 10 or 
12 years of age ; the spasms were very frequent and extreme- 
ly severe, every paroxysm apparently putting the life of the 
patient in imminent danger: the veratrum, to reduce the fre- 
quency of the pulse, and ether inhalations, to quiet the spasms, 
were the remedies almost exclusively relied upon ; and these 
indications were fulfilled in the happiest possible manner, snatch- 
ing the little sufferer from the very jaws of death. 

The case of rheumatism occurred in a little boy about 5 years 

1853.] Wilson, on Veratrum Viride. 391 

of age; it attacked the knee-joint, was very severe, and was 
treated principally with colchicum and veratrum; but the for- 
mer medicine did not succeed well until the latter was added to 
prescription. Under this treatment the disease was subdued 
in less than six days, instead of running " six weeks," according 
to the dictum of Dr. Warren. 

The case of dropsy was fatal, the patient being moribund 
when the veratrum was commenced. 

We now come to that interesting class of diseases — fevers. 
Of the three typhoid cases, one terminated favorably in twelve 
days ; but the early convalescence in this case was not attribu- 
ted to the veratrum, as this was not made a principal remedy, 
and as the fever was unusually mild. The other two cases 
were severe and protracted, one continuing three and the other 
six weeks. Having much confidence in the veratrum, it was 
relied upon almost exclusively in the treatment of these two 
cases, the prescriptions being complicated as little as possible. 
In the case that terminated in convalescence in three weeks, 
slight ptyalism supervened, from the use of small doses of calo- 
mel in conjunction with the veratrum. 

The general plan of treatment which I have adopted in ty- 
phoid fever is to give quinine freely for the first few days, or 
until the typhoid symptoms are fully developed ; I then resort 
to small doses of calomel and the veratrum, experience having 
taught me that nothing can be gained by pushing the quinine, 
after the disease has become distinctly typhoid. In giving the 
veratrum, I generally prescribe 4 gtt. every three hours, for an 
adult, to be increased 1 gtt. each dose, until a decided effect is 
produced, either upon the pulse or stomach. I have never 
been able to carry the dose higher than 14 gtt., and seldom 
higher than 8 gtt. ; and I have even known 2 gtt. to produce 
a very manifest effect on the pulse of a little girl three years 
of age. I have never known it to fail in reducing the frequency 
of the pulse when it produced nausea, but I have frequently 
succeeded in reducing the pulse, without any nausea, by begin- 
ning with very small doses, and increasing gradually. 

Having mentioned the diseases in which I have used the 
veratrum, and the mode of administration, I conclude with a 
few general ssmarks. 

392 Wilson, on Veratrum Viride. [July, 

It will be seen by reference to the figures given, that my 
experience with it has been more extended in pulmonary dis- 
eases than in any other class — sufficiently so, I think, to speak 
with some degree of confidence. As already stated, only one 
of those cases proved fatal, and that was complicated. Some 
of the cases were severe and alarming, as much so as any I 
have ever seen ; and one of the cases of pneumonia was accom- 
panied with active pulmonary hemorrhage. With these facts 
before me, I can but express a very favorable opinion of the 
veratrum in pneumonia and bronchitis. Before the introduc- 
tion of this remedy, I treated the diseases mentioned with 
antimonials, and generally with success ; but every physician 
of experience knows that pneumonia is not unfrequently com- 
plicated with a degree of intestinal irritation which forbids the 
use of tart, emetic on the Rasorian plan, or, indeed, in any way 
capable of subduing the pulmonary inflammation: and even 
where this intestinal complication is not an essential feature of 
the disease, it is well known that the free use of tart, antimony 
will produce it, together with other grave, and even fatal symp- 
toms. The veratrum is not obnoxious to those objections ; and 
having in addition to the important negative advantage, the 
positive one of being more prompt and certain in its effects, 
than the antimony, I think it entitled to the preference ; and I 
think it possible that time and experience will confirm its 
claims, and that it will be recognized as the great desideratum 
in the treatment of pulmonary diseases. In this class of dis- 
eases I have found it to act promptly, not only as a sedative, but 
also as an expectorant and anodvne ; and I would here remark, 
that I consider its primary action, that which gives it its great 
value, sedative — while its secondary effects ar